Psychiatric Times Vol 21 No 7

I imagine a restored Rolls-Royce Silver Cloud with running boards, an oak trunk, the silver

Three studies over the past three years show that individuals over age 65 who are suffering from depression may still not be receiving the treatment they need. Is integrating treatment into primary care the answer?

This introduction article elucidates how the various contributions to this special report help make psychiatry such a rich and varied field.

Organizational and occupational psychiatry represents the extension of psychiatric knowledge and skill to the day-to-day functioning of individuals in the workplace and their organizations, with the goal of helping both to function better. To this end, psychiatrists have played an important role both in the treatment of workers and consultation to organizations since the early part of the 20th century.

Adults who are severely mentally ill are over-represented in U.S. jails and prisons, leading to an interface between the mental health and criminal justice systems. New intervention strategies involving both systems, such as mental health courts and forensic assertive community treatment, could divert patients away from the criminal justice system and promote engagement in community-based treatment and support services.

Many psychiatrists limit the application of their skills to individuals whose discomfort matches the phenomenological criteria of DSM-IV-TR. Can psychiatry transcend the concept of "objective cure" and include "subjective perfection" as a goal? Is there a logical reason why the concept of "treatment pills" cannot coexist with that of "lifestyle pills" on the psychiatric prescription pad? Dr. Giannini reflects on whether there can be both "cosmetic" as well as "reconstructive" psychiatry and if a disease is needed in order to be treated.

Hollywood has had a long-standing love affair with psychiatry and its portrayals of electroconvulsive therapy reflect and influence public attitudes toward the treatment. One-third of medical students decreased their support for the treatment after being shown ECT scenes from movies, and the proportion of students who would dissuade a family member or friend from having ECT rose from less than 10% prior to viewing to almost 25% afterward. So what is the legacy of portrayals that have been so abhorrent, and are there any exceptions to the rule?

What are some of the pitfalls of treating patients from varying cultural backgrounds, what cultural issues should psychiatrists be aware of and how can they fit varying culturally based psychiatric disorders into a proper diagnostic framework? Using case studies, Dr. Moldavsky explores the clinical implications of culture in psychiatric practice.

What are the qualities of forensic psychiatry? In reviewing the basis on which forensic psychiatry is defined as a specialty or, more accurately, a subspecialty of psychiatry, the author discusses the altered relation between physician and "subject," the consultative role in relation to the legal system, and the areas of specialized knowledge and skills that attend the field.