Psychiatric Times Vol 19 No 6

As a psychiatrist working in a state hospital, this author defends the long-term commitment of sexual offenders to institutions and offers insights on factors determining prognosis.

What effects will the verdict from the murder case against Andrea Yates have on the public's view of the insanity defense?

When I raise my rates he folds his fifty dollar co-pay and slides it up my desk like an enlisted man on leave easing a big bill in a stripper's G-string. He tells me I'm like his war-time whore who loved him on payday and left when his money ran dry. Each week I lead him in our dance, excite him with my offer to listen to his dreams. And I tell myself I do it to ease his suffering, because I get paid, because I took an oath. But every month, when we devour another round of sessions, I fill out forms for insurance pimps who won't pay unless I reveal the private parts.

It is amazing how a psychiatric practice changes over the years including the switch to managed care from fee-for-service, larger caseloads, new medications and new treatment options. Despite all the changes, both for better and for worse, one psychiatrist is enjoying his practice as much today as ever before.

Antidepressant use among children and adolescents is on the rise. What prescribing patterns are being formed? Researchers are suggesting that more research into psychiatric pharmacogenetics may produce better treatment outcomes. Will it one day be possible to predict treatment response?

Advances in basic behavior and neuroscience research have been stunning, but until quite recently, efforts to encourage the clinical application of new knowledge have not kept pace. To aid in applying new knowledge to important public health issues, the National Institutes of Health has placed emphasis on "translational research," which aims to provide a bridge between basic research and clinical care. Particularly promising areas of study are highlighted.

Personal digital assistants have the ability to make your practice more efficient. What are the choices of PDAs on the market, and which one is best for you?

How has the emphasis on economics and mental health care affected the quality of care? Has it improved under managed care? Implementing prevention strategies and improved quality, although initially costly, may save money in the long term.