Psychiatric Times Vol 27 No 1

There are very few, if any, direct mental health provisions in the congressional health care legislation that has passed the House and is now awaiting Senate approval. The Senate bill-the Patient Protection and Affordable Care Act (HR 3590)-debated on the floor in December is similar in some respects to the Affordable Health Care for America Act (HR 3962), which the House passed by an extremely thin, Democrat-heavy vote of 220-215 on November 7, 2009. Both bills appear to extend mental health parity to individual and group policies sold within new health insurance Exchanges. They would also expand Medicaid, begin funding medical home demonstrations, and ban insurance companies from denying policies based on an applicant’s preexisting condition.

Of particular utility in the position statement is a checklist for identifying children who are at risk for sudden death, independent of ADHD or stimulant drug treatments.

Since the inception of the modern era of psychopharmacology, psychotropics have been the mainstay of the care of psychiatric patients all over the world, irrespective of their cultural and ethnic backgrounds. Until recently, however, variations in treatment response across populations, including effectiveness, dosing strategies, and adverse-effect profiles, have received minimal attention.

The onset of psychiatric illness in a child is a life-changing event for families. Families from immigrant and ethnocultural communities often must come to an understanding of their child’s psychiatric difficulties while simultaneously interacting with an unfamiliar health care system and its practitioners.

-after reading about a health insurance company CEO’s $19,000,000 paycheck

During the past 2 decades, there has been enormous growth of interest in and visibility of cultural psychiatry. Much of this is due to the steady increase in migration of the world’s population from low-income to higher-income regions and countries.

Until the early 19th century, psychiatry and religion were closely connected. Religious institutions were responsible for the care of the mentally ill. A major change occurred when Charcot1 and his pupil Freud2 associated religion with hysteria and neurosis. This created a divide between religion and mental health care, which has continued until recently. Psychiatry has a long tradition of dismissing and attacking religious experience. Religion has often been seen by mental health professionals in Western societies as irrational, outdated, and dependency forming and has been viewed to result in emotional instability.3

The term “evidence” has become about as controversial as the word “unconscious” had been in its Freudian heyday, or as the term “proletariat” was in another arena.

What do we know about circadian rhythms and melatonin? And what further lessons do we need about circadian rhythms, light exposure, and melatonin to help our patients with disturbed sleep/wake cycles?

CATIE can be viewed as a switch study. Switches offer both opportunity and risk. Data from CATIE demonstrate differences in overall effectiveness, but these differences depend on the individual patient context.

The ancient role of conscience as a moral pilot is rejuvenated, and its neglected function as a spiritual daemon is refurbished for more psychologically minded modern readers.

After formulating and signing “Melancholia: A Declaration of Independence,” an international cadre of psychiatrists recently launched a campaign to have the upcoming DSM-V recognize melancholia as a distinct syndrome rather than as a specifier for the mood disorders of major depression and bipolar disorder.

This commentary suggests how the research community can be instrumental in improving DSM-V and helping it avoid unintended consequences. According to several converging, anonymous (but I think quite reliable) sources to which I have had access, the draft options for DSM-V will finally be posted between mid-January and mid-February 2010. There will then be just 1 month (until mid-March) for collecting comments. The good news is that the products of a previously closed process will finally be available for wide review and correction. The bad news is that there will be only a brief period allotted for this absolutely crucial input from the field.

On October 19, 2009, the Office of the Deputy US Attorney General issued a memorandum, “Investigations and Prosecutions in States Authorizing the Medical Use of Marijuana.”1 The memo announced a federal policy to abstain from investigating or prosecuting “individuals whose actions are in clear and unambiguous compliance with existing state laws providing for the medical use of marijuana.” The memo made clear, however, that it did not “legalize marijuana or provide a legal defense to a violation of federal law.” Rather, it was “intended solely as a guide to the exercise of investigative and prosecutorial discretion.”

Respecting the article “Abortion Trauma Syndrome” by Arline Kaplan, I would note the irony of the claim that this syndrome is “conceived by anti-abortion activists to advance their cause,” given the obvious pro-abortion attitude of everyone associated with Kaplan’s article.