Psychiatric Times Vol 15 No 10

The obvious sometimes bears repeating: Sick people have trouble thinking. They may be suffering from a delirium, a dementia or a more subtle disturbance of cognition caused by fever, drugs, infection, inflammation, trauma, hypoxemia, metabolic derangement, hypotension, tumor, intracranial pathology, pain and so forth.

Consultation-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.

Atypical antipsychotic treatment for borderline personality disorder (BPD) and augmentation therapy with olanzapine (Zyprexa) or estrogen replacement therapy (ERT) for patients with mood disorders were among the research questions addressed at the American Psychiatric Association's annual meeting in Toronto. Following are some brief reports of selected presentations.

The future is both bright and dark for consultation-liaison (C-L) psychiatry. It is a paradox created by a still-evolving health care system that affords unique opportunities for innovation, while simultaneously placing seemingly insurmountable obstacles in the way of access to quality care. Striving to navigate these systemic contradictions, C-L psychiatry can be seen as on the verge of either a breakthrough or a breakdown-only time will tell how things will work out for this as yet uncertified subspecialty.

William - Poetry of the Times

As health care continues to shift in the United States from fee-for-service to managed care, and away from specialist-driven care to the primary care gatekeeper, it is necessary to re-examine psychiatric training and the psychiatric services that are being provided.

When Sigmund Freud gave his epochal lectures at Worcester's Clark University in the early 20th century, a young Harvard student named Alan Gregg was in the audience. Upon completion of his medical education and training as an internist, he would become a great visionary of psychiatry's role in the practice of medicine.

New methods of conducting and evaluating research were as intriguing as their results at the National Institute of Mental Health (NIMH)-sponsored New Clinical Drug Evaluation Unit Program's (NCDEU) 38th annual meeting in Boca Raton, Fla., June 10-13. The meeting has grown from a forum of NIMH-funded researchers reporting on their progress into a convention of approximately 1,000 clinicians, industry and regulatory personnel, and investigators marking the progress in psychopharmacology.

The diagnostic criteria for sexual addiction are derived from the behaviorally nonspecific criteria for addictive disorder that were presented in Part 1 (Goodman, 1998b), by replacing "behavior" with "sexual behavior".

Because of the very prominent physical symptoms of panic disorder, many see their primary care doctor or a specialist, such as a pulmonologist, first.