Psychiatric Times Vol 19 No 7

The tragedy of Sept. 11, 2001, brought so much public attention to mental health care that the National Institute of Mental Health has awarded several grants for the study of the needs incurred following these attacks. Grants were given to Cynthia Pfeffer, M.D.; David Vlahov, Ph.D., and Gerry Fairbrother, Ph.D.; Rose Zimering, Ph.D.; Charles Marmar, M.D.; Hector Bird, M.D.; Edna Foa Ph.D., and Rachel Yehuda, Ph.D.; Joseph LeDoux, Ph.D.; Daphne Simeon M.D.; and Joann Difede, Ph.D. These researchers from various universities and institutions were given grants to support or continue research on topics such as Sept. 11's effects on mental health symptoms, disorders and care service use; posttraumatic stress disorder (PTSD) and other disorders in children as a result of losing a parent in the attacks; and PTSD in clinicians treating victims of the attacks.

With black bags stuffed below their eyes, all the sad doctors come to me now like mourners in the time of plague. Crying in their office bathrooms, carrying boxes of charts home at night, they are too tired to eat, and sex excites them less than a committee meeting. Without dreams, their eyes watch the clock tick off the wounded hours-thousands of doctors writhing on the scarred suture line of American medicine like a cargo of used syringes washed up with drowned birds on an oil-soaked beach.

The World Health Organization (WHO) has distributed for comments the draft of a Manual on Mental Health Legislation as a guide for all the countries of the world. It is to serve as a model for new legislation and as a guide for countries amending their legislation. Given the different legal systems, the cultural diversity and the vast inequalities in economic resources among the nations of the world, one can certainly question the wisdom of the WHO's top-down approach. In addition, everyone who knows the scarcity of competent mental health care professionals and the limited resources in third world countries will recognize that most of the proposals are quite unrealistic. How can nations who cannot feed their poor or meet the basic necessities of public health measures and primary care be expected to provide "incompetent" mental patients with counsel (lawyers) and independent tribunals (courts) before they begin to treat them?

With the failure of previous federal plans to reform health care, other options must be considered. How might this effect the reimbursements for providing care?

Psychopharmacology can be useful in all stages of couples' therapy. Using a high-functioning couple as a case example, the author illustrates how psychopharmacology, together with psychotherapy, can be used to facilitate treatment success.

Psychiatrists, neurologists, primary care physicians, physician assistants, psychologists, psychiatric nurses, social workers and other mental health care professionals. Continuing education credit is available for most specialties. To determine if this article meets the requirements of your specialty, please contact your state licensing board.

While anorexia nervosa was the first eating disorder to be recognized through the 19th century reports of Gull (1874) and Lassque (1873), bulimia nervosa and the less well-defined eating disorder not otherwise specified (EDNOS) syndromes are more common.

How can psychiatrists and psychotherapists optimize their collaboration and individual skills to facilitate treatment success?

There is no question that psychotherapy and psychopharmacology can be successfully integrated. Indeed, there are still many psychiatrists left in this country who talk to patients and families, provide both psychotherapy and psychopharmacology, and care for patients in a biopsychosocial context.