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Among the numerous challenges facing psychiatric care providers today, few experiences are as ubiquitous as treatment refusal. Tragically, it is often the case that the very patients who are most inclined to refuse treatment are the ones who are in most need of it.

Several readers have responded with comments and concerns regarding my column, "Do Physicians Use Practice Guidelines?" Since the issues these readers raised are important and concern many psychiatrists, they merit some discussion.

One of the major concerns of health professionals working in the area of psychiatry is understanding the conditions under which patients adhere to prescribed treatments. While adherence is linked to some extent to the patients' comprehension of their illness, it is also a function of their social and demographic characteristics, such as age, social milieu, or sex. Another attribute also merits our attention, however: the patient's cultural affiliation and in particular, his or her religious background.

As the United States becomes more culturally, racially, and ethnically diverse, psychiatry will be faced with the need to treat more diverse populations. This article focuses on challenges and obstacles encountered when treating black patients with mental illness.

Dr Steven King provided an interesting summary of complex regional pain syndrome (CRPS) in Psychiatric Times (Complex Regional Pain Syndrome, June 2006, page 9). We felt it would be useful to provide some additional observations on the relationship between CRPS type I and psychological causes of pain.

A discussion of the intellectual, social, and historical similarities and differences between sacred texts and the DSM would require a full-length book, but we will concentrate here on 5 main aspects: controversy, communication, interpretation, change, and power.

Analyzing data gathered in a 10-nation study of psychoses by the World Health Organization (WHO), Susser and Wanderling1 found that the incidence of nonaffective psychoses with acute onset and full recovery was about 10 times higher in premodern cultures than in modern cultures. Transient psychoses with full recovery were comparatively rare in modern cultures. Such a dramatic difference begs for explanation.

Mostly because of increased speed and decreased costs of communication and transportation, cities are growing increasingly diverse in their population. Consequently, cultural factors have taken center stage in the understanding of urban mental health. This article will focus on the main approaches to urban mental health and briefly summarize the 3 lines of research in this area. It will then discuss the main themes of a vast body of literature on the cultural aspects of urban mental health.

Should psychiatrists follow these leads and use a patient's race or ethnicity to guide treatment decisions? In this article, I will describe the evidence that supports racial profiling in psychiatry and will explore some of the relevant concerns.

Compared with the many recent articles addressing medications' multiple meanings for the patients who take them and the psychiatrist-therapists who prescribe them, there has persisted in the literature and in clinical practice a curious literal conception of the prescription itself. This article challenges the idea that the only medication that can be prescribed comes in the form of pills or tablets; on the contrary, ideas constitute some of the most potent "medication" known.

In a recent article on genetic counseling in psychiatry, Christine Finn, MD, and Jordan W. Smoller, MD, ScD, noted that family and twin studies have documented the familiality and heritability of schizophrenia, bipolar disorder, major depression, anxiety disorders, autism, attention-deficit/hyper- activity disorder (ADHD), and Tourette syndrome, among others, and that molecular genetic studies have begun to identify possible susceptibility loci for several of these disorders, most notably schizophrenia.

Compared with other ethnic groups, Asian Americans underuse mental health services, resulting in delayed treatment and higher attrition rates. A report by the surgeon general states that the underutilization is because of the shortage of bilingual services, the low percentage of health care insurance coverage, and the Asian American tradition of using mental health treatment only as a last resort.

In this essay, I approach the question about the BPSM from the perspective of a teacher of psychiatry, medical school dean responsible for (among other matters) student career advising, and clinician. In those capacities, my duties include fostering an understanding of psychiatric disorders among medical students and residents, instilling confidence in and respect for the discipline of psychiatry among students as well as nonpsychiatric colleagues, and explaining psychiatric diagnosis and treatment to patients and their families.

Recently, 3 reports that shed further light on the short- and long-term mental health consequences for children of depressed parents were published.

In July 2005, the FDA approved a new type of therapy for treatment-resistant depression: vagus nerve stimulation (VNS). However, the approval process incited controversy because the scientific team that was assigned to review the device rejected its approval unanimously 3 separate times. The reviewers were unimpressed with the efficacy research underlying the device, since the only reported placebo-controlled trial showed no significant difference between active and sham VNS.

Psychotic symptoms--delusions, hallucinations, paranoia, thought disorder--are mostly attributed now to aberrations in brain structure and function.

The skin is the largest organ of the body and functions as a social, psychological, and metabolically active biologic interface between the individual and the environment.

Traditional physical therapy for neurologic conditions can be boring for the patient and tiring for the physical therapist, making it difficult to put in the required number of training hours. That is why researchers are developing a new generation of physical therapy tools that use video games, robotics, and virtual reality.

Among the many changes in psychiatric practice often attributed to the psychotherapist Carl Rogers was a shift in the therapist’s relationship with the patient. In particular, Rogers is rightly famous for advocating a “client-centered” or “person-centered” therapy.

Last May, the Church of Scientology's Citizens Commission on Human Rights (CCHR) distributed 50,000 copies of a new booklet entitled Psychiatry--Education's Ruin, complete with a cover photo of drugged-looking school kids at desks. The CCHR logo on the cover resembles a federal government seal, with a hand holding up scales of justice. Beneath the logo are the words: "Published as a public service by the Citizens Commission on Human RightsTM."

Investigational drugs and novel applications of established agents for psychiatric illness were described in a number of reports at the 46th annual NIMH-sponsored New Clinical Drug Evaluation Unit (NCDEU) meeting in Boca Raton, Fla, June 12-15, 2006.

I'm starting out. For 3 years in my Resident's Column, I've shared the excitement, frustration, and even outright anger that I experienced as a second-career psychiatry resident. Because I had completed a different residency years earlier, I was in the position to step back a bit and observe my experiences in a way that would have been impossible the first time around.

According to the National Institute on Drug Abuse (NIDA), gender differences can influence the causes, effects, consequences, and treatment of substance abuse disorders. A recent NIDA News Scan focused on several investigations supported by the NIDA.

A report issued in September by the Department of Justice citing the prevalence of mental health problems among prisoners in federal and state prisons and local jails was called “an indictment of the nation's mental health care system” by Michael J. Fitzpatrick, MSW, executive director, National Alliance on Mental Illness.

A new and greatly improved search engine made its debut this month on the Psychiatric Times Web site (www.psychiatrictimes.com). The engine will facilitate searching for articles archived on the site-but it is designed to go far beyond that to provide a clinician-friendly means of searching the World Wide Web for relevant psychiatric and medical information.

Certainly, with the advent of the atypicals, it has become almost too easy to forget about doing an Abnormal Involuntary Movement Scale (AIMS) checklist. Given the time and reimbursement constraints of current psychiatric practice, however, it is close to impossible to find time for clinical rating scales.

Concerns about senior suicide and the lack of geriatric mental health services took center stage at hearings in the Senate Special Committee on Aging on September 14. Geriatric psychiatrists reviewed unfavorable trends such as faltering numbers of medical school graduates going into primary care and already small numbers of geriatric psychiatrists getting even smaller.

It may come as a surprise, especially given its low repute in the popular mind since the 1980s, but electroconvulsive therapy (ECT) is making a comeback, both as a recommended treatment for depression and in public awareness.

Patients with somatization disorder (SD) who are treated using the psychiatric consultation intervention (PCI) may benefit from the addition of cognitive behavioral therapy (CBT) to their regimen. Dr Leslie A. Allen and colleagues recently conducted a randomized controlled trial to determine the outcomes of patients with SD who were treated using a combination of CBT and PCI or treatment with PCI alone. The results were reported in the July issue of Archives of Internal Medicine.

Most psychiatrists and other physicians routinely prescribe medication for off-label use. This article focuses on how to minimize patient harm from off-label therapies and how to protect oneself from legal problems that may arise from off-label prescribing.