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Forensic examinations involving children and adolescents are particularly difficult, due to the vulnerability of this patient population. What ethical guidelines should be followed and what sorts of pitfalls should clinicians attempt to avoid?

Attempting litigation based on a claim of posttraumatic stress disorder can be difficult. What is the proper DSM definition of PTSD and in what ways can and can't it be used in court to properly defend a client? What should the role of the psychiatrist be in this process?

Forensic psychiatry is increasingly emerging into treatment psychiatry as a respected subspecialty. However, there are important clinical and business distinctions between the practice of treatment psychiatry and the practice of forensic psychiatry. The essential components of setting up a forensic psychiatry practice are outlined.

Several significant factors have converged to impact and heighten concern about the potential for malpractice litigation related to psychopharmacology. Current influences as well as frequent sources of professional liability risk related to psychopharmacology are reviewed and suggestions for preventing and reducing risk are made.

Consultation-liaison psychiatrists frequently encounter clinical situations that have legal implications. Competency evaluations, which are the most common legal question in C&L psychiatry, are reviewed in this article. In addition, the authors discuss guardianship, decision making in patients who refuse treatment, confidentiality and the role of the psychiatric consultant in against medical advice discharges.

How did the author of the controversial book Listening to Prozac become a psychiatrist instead of a writer as he had planned, and how did he manage to fulfill both career goals?

The multitalented psychiatrist talks with Psychiatric Times about his research, his literary work and the future of psychiatry itself.

Patients with Alzheimer's disease may suffer the same age- and disease-related changes to sleep as their age-matched peers. However, as the dementia progresses, even more severe disturbances develop, with impairments in both nighttime sleep continuity and daytime alertness. This article focuses on long-term, holistic approaches to treatment, including environmental and behavioral interventions to augment sleep medications.

Affecting 70% of patients with Alzheimer's disease and common in patients suffering from other dementing illnesses, apathy is associated with functional impairment and caregiver distress at all levels of disease severity. Assessment and treatment for this under-recognized syndrome are discussed.

Advances in technology are providing assistive and supportive interventions for people with dementia across all aspects of their lives. These interventions are mainly addressed at meeting the safety, security and social needs of people with dementia. The psychological needs of people with dementia for conversation and other forms of positive social interactions are also being tackled through developments such as the CIRCA project.

Pantoum From a Line by Pablo Neruda

Patients with HIV infection are at risk of developing psychiatric symptoms and disorders similar to those seen in the general population. What unique biological, psychological and environmental factors are involved in treating this population?

The United States is facing accelerated growth in the number of older citizens due to the aging baby boomer generation. It is expected that this emerging cohort will have more licensed drivers who will drive longer distances more frequently and later into life than preceding generations. What are the risks from elderly drivers and how can we help them drive safely?

Elderly patients are a heterogeneous population with myriad issues facing them. The group of articles in this Special Report should stimulate thinking, discussion and future research in a variety of areas.

Three psychiatrists give their perspective on helping victims of one of the nation's worst natural disasters.

Published a decade ago, the original National Comorbidity Survey focused largely on anxiety and depression. In an exclusive interview, the survey's designer, Ronald C. Kessler, Ph.D., talks with Psychiatric Times about the just-published replication study, which found that the combined lifetime prevalence of impulse control disorders is higher than that for either mood or substance use disorders.

Insights Into Depression and Anxiety:What Roles Do Anxiety Disorders Play in the Treatment of Depression?

Carpenter LL, Schecter JM, Underwood JA, et al. Service expectations and clinical characteristics of patients receiving psychiatric emergency services. Psychiatr Serv. 2005;56:743-745.

Affected patients with intractable epilepsy are treated, often for years, with antiepileptic drugs and other interventions that can promote further morbidity.

Parkinson disease, Disease management

pay for performance, reimbursement

Signals

epilespy, focal epilepsy, temporal lobe epilepsy, 3 Tesla phased array MRI, surgical intervention for epilepsy

epilepsy, seizures

Two new recommendation papers--one on the use of serum prolactin (PRL) in the differential diagnosis of epileptiform seizures and the other on use of carotid endarterectomy (CE) in stroke prevention--were released this past September by subcommittees of the American Academy of Neurology (AAN).

Alzheimer disease, dementia, Parkinson disease, multiple sclerosis, caregiver, caregiving

Creutzfeldt-Jakob disease, wheelchair, Parkinson disease, rasagiline, selegiline

HIV/AIDS, peripheral neuropathy, sensory neuropathies, subjective peripheral neuropathy screen

Opiate detoxification in the outpatient setting often depends on what services are available in the community. Many clinicians think that a methadone maintenance or taper regimen, combined with substance abuse treatment therapy, offers the best chance to prevent relapse. If possible, enrolling a patient promptly in such a program should be considered. Regardless of detoxification method, referral for psychosocial drug treatment is indicated.

A number of highly publicized cases in the lay press have underscored the significance of, and dangers associated with, perinatal psychiatric illness. Unfortunately, the field of psychiatry has failed to use these tragic cases to disseminate accurate information and educate the public about the high frequency of perinatal depression and anxiety, as well as the relative rarity of postpartum psychosis and infanticide. Moreover, psychiatrists continue to have difficulty in educating their medical colleagues about the need to screen for these illnesses, so most obstetricians and pediatricians still do not screen for perinatal depression and anxiety, much less manage it effectively. Decisions about appropriate treatment are further complicated by a lack of empiric outcome data.