Diagnoses from Clinical Evaluations and Standardized Diagnostic Interviews Don’t Agree
April 20th 2010A recently published a meta-analysis showed that diagnoses generated from clinical evaluations often do not agree with the results of structured and semi-structured interviews-together called standardized diagnostic interviews (SDI).1 Such a study could easily be overlooked as another dry and “methodological” investigation. Nevertheless, the implications of this meta-analysis are enormous
Psychiatrists, Physicians, and the Prescriptive Bond
April 16th 2010Almost the first memory I have of a physician is our family doctor at my bedside, leaning over to press his warm fingers against my neck and beneath my jaw. I’m 5, maybe 6 years old. I have a fever and a sore throat, and Dr Gerace is carefully palpating my cervical and submandibular lymph nodes. In my family, Dr Gerace’s opinion carried a lot of weight. It was the 1950s, and my mother did not quite trust those new-fangled antibiotics. She usually tried to haggle with the doctor over the dose-“Can’t the boy take just half that much?”-but even my mother would ultimately bow to Dr Gerace’s considered opinion.
The Psychologist Prescribing Bill is Dead--Long Live Science in the Public Interest!
April 10th 2010Oregon’s Governor Kulongoski has vetoed a bill that would have allowed psychologists to practice clinical medicine without adequate training-otherwise known by the euphemism of "prescribing." The Governor's rationale was precisely the one opponents of the bill, such as myself, had advocated.
The State of Pharmacogenetics Customizing Treatments
April 9th 2010There are limited data on clinical and biological predictors of antipsychotic drug response. The ability to identify those patients who will respond well to psychotropic drug treatment or who will be at a higher risk for adverse effects could help clinicians avoid lengthy ineffective drug trials and limit patients’ exposure to those effects. Moreover, better predictability of treatment response early in the course of a patient’s illness can result in enhanced medication adherence, a significant predictor of relapse prevention.
Psychiatric Diagnosis Gone Wild: The "Epidemic" Of Childhood Bipolar Disorder
April 8th 2010Mark Twain observed that "the past may not repeat itself, but it sure does rhyme." An unfortunate rhyme in psychiatric history is the recurrence of fad diagnoses. Childhood Bipolar Disorder is the most dangerous current bubble, with a remarkable forty-fold inflation in just one decade.
ADHD and Comorbid Substance Use Disorder
April 7th 2010Epidemiological studies show that, 4% to 5% of the general population have severe ADHD. Of this number, half have a comorbid substance use disorder. The aim of this article is to help physicians understand and manage this challenging combination of comorbidities.
A Clinician’s Guide to Statistics and Epidemiology in Mental Health: Measuring Truth and Uncertainty
April 7th 2010Is A Clinician’s Guide to Statistics and Epidemiology in Mental Health what we have been waiting for? Yes and no. It contains solid descriptions of concepts such as the P value and confidence intervals, and it has extensive discussions of the history of modern statistical methods. Perhaps its greatest strength involves critiques of the interpretations of several studies that have mistakenly become cornerstones of clinical lore.
Are FDA Warnings on Antipsychotics Heeded?
April 7th 2010The impact of FDA alerts and label warnings was examined in 2 recently published studies of antipsychotic drug use. In one study, researchers gauged physician response to the 2005 warning of increased mortality with antipsychotic use in elderly patients with dementia, and in the other study, researchers determined whether recommended safeguards were implemented following the 2003 advisories on adverse metabolic effects of second-generation antipsychotics.
Psychologist Prescribing Privileges: Bias and Risk Assessment
April 5th 2010Oregon’s legislature has passed the bill: should the governor sign it? Most opinions on this issue are strong, and many have reached the point of invective. Even such a cool mind as Ronald Pies' has weighed in with an emotionally charged editorial.1 To speak in favor when so many are opposed seems only to invite more affective discharge. On the other hand, editorial views thus far may be moving us toward extremes on an issue that is highly complex. Perhaps a dialectic approach -– what value can we find in an opposing view? -- would be wise at this point. In that spirit, here are 4 considerations that I hope will be useful.
Emotional Comunicating-Via Touch
April 3rd 2010You stand blindfolded in a lab. A stranger approaches you but does not speak or make any sounds. This person will touch you in a manner that is intended to convey 8 different emotions. Your role in this experiment is to “decode” the tactile sensations you feel and determine whether they convey anger, fear, happiness, sadness, disgust, love, gratitude, or sympathy.
Challenges Faced by Psychiatrists in the Internet Age
April 2nd 2010In January of my third year of medical school while attempting to study for my medical licensing examination, I began a blog. (Any distraction from learning about the Krebs cycle was heartily welcomed!) Within a week, I had posted photos of my family members, criticized an episode of ER, and griped about my studies. A social addict, I was hooked on this self-disclosure.