Psychiatric Times Vol 16 No 8

Planning for the turn of the century is a little bit like defensive driving: You have to watch out for the other guy and pay close attention to what you're doing.

Lobster Alchemy - Poetry of the Times

With the end of the Cold War, there is a new dimension to America's military entanglements. The demise of the Soviet bloc has opened the door for the U.S. military to take a more active role in political hot spots, with the result being an increasing willingness to engage in peacekeeping and humanitarian operations throughout the world.

More than 430 psychiatrists, research donors and others gathered in late October for the National Alliance for Research on Schizophrenia and Depression (NARSAD)'s awards dinner in New York City. The black-tie fundraising event was held in conjunction with the organization's 10th annual scientific symposium at which 15 selected NARSAD grantees presented their ongoing research over two days of sessions devoted to basic science, schizophrenia and depression.

Psychological testimony is required in more than half the civil trials that unfold each year in the nation's courtrooms, and it is a rare criminal case that doesn't include a psychiatric evaluation during some stage of the proceedings. Yet despite the significant number of interactions between lawyers and forensic psychiatric experts that occur daily, there is still a fault line that separates them.

When do therapists legally owe a duty of care to persons other than their patients? It is an axiom that good medical care involves consideration not only of the patient but also of others. In law, the general principle is that the risk which may result from one's behavior, as reasonably perceived, determines the duty of care.

It is relatively recent that boundary issues in clinical practice have attained professional awareness, although some early concepts portended the issue. Several decades ago, for example, the term boundary violations referred almost exclusively to what we now term sexual misconduct.

Let us begin with an example. Suppose I am traveling from the United States to Switzerland, anticipating skiing with my son in the Alps. My anticipation becomes vivid and lively. I recall excitement mixed with joy at rapidly soaring down the mountainside, and I am now quite anxious to re-experience this thrilling adventure with my son-eager to be heading down the mountain with him. Later, as we stand on the crest of a deep and winding slope, the speed, thrill and admixture of danger and adventure will infuse my being.

Income increased for psychiatrists in 1997, although it dropped for the combined all-physicians category. Dissemination of physician income data became a controversial issue at the AMA House of Delegates meeting last year (Baldwin, 1999; Booth, 1999). Angered by media reports of rising physician income without consideration of hours worked or differences between demographic groups of physicians, delegates voiced concern with the AMA's collection and release of physician income data.

Schizophrenic patients treated with olanzapine (Zyprexa) required less health care services and incurred less overall health care costs over a 28-week period than patients treated with risperidone (Risperdal). This was the result of a study presented by Eli Lilly and Company researchers at the European College of Neuropsychopharmacology meeting held in Paris from Oct. 31, 1998 to Nov. 4, 1998.

Other Hormones on Behavior - Poetry of the Times

One day after Eli Lilly and Company researchers reported finding olanzapine (Zyprexa) superior to risperidone (Risperdal) on some measures in a 28-week comparative study presented to the American College of Neuropsychopharmacology (ACNP) meeting in 1996, Janssen Pharmaceutica Inc. issued a press statement critical of the methodology and results of the study. Janssen then announced it would undertake its own comparative trial. The results of this trial's initial eight-week acute treatment phase were presented at the European College of Neuro-psychopharmacology meeting held Oct. 31, 1998, through Nov. 4, 1998, in Paris. They indicate risperidone has an advantage for positive symptoms such as hallucinations and delusions, and for anxiety/depression in patients with schizophrenia and schizo-affective disorder.