News

In warn-torn Afghanistan, refugees continue to struggle to survive in 20-year-old "temporary" shelters, without proper food and suffering from the psychiatric consequences of trauma. What are psychiatrists doing to help?

Dropping the Lamb

Mandatory reporting laws rarely require reporting by psychiatrists. Psychiatrists need to treat the patient, rather than act as mandated reporters, and be knowledgeable about the dynamics and consequences of domestic violence and about available community resources and advocates that can help the patient.

A bill just signed into law by New Mexico's governor will allow psychologists to obtain prescribing privileges. Will this provide more care to underserved populations, or will it simply put patients at risk?

While the public perceives that many criminals escape punishment by pleading insanity, the truth is that very few people are ever found not guilty by reason of insanity. Society has to decide whether they want to lock up everyone who does any bad thing or excuse the behavior of people who are not capable of controlling their own behavior.

What is a psychiatric expert and how does their role differ from that of the clinician? What must you consider before deciding to serve as an expert witness?

Although it may be tempting to say that almost any rewarding activity can become addicting, new research appears to indicate that, at least in the case of Internet use, that may not be the case. In fact, "Internet addiction" may actually be a sign for other psychiatric disorders.

In the 1800s there was widespread concern over the increase in the number of individuals with severe mental illnesses. Evidence from the 20th and 21st centuries is building that shows a similar trend. Why, then, is this increase not being currently addressed?

Despite the fact that recent juries have discounted repressed-memory testimony as viable, the emotional cost of such cases still takes its toll. Why are such cases so controversial, and how can psychiatrists avoid their pitfalls?

Psychiatrists can help employers better understand the effects of personality disorders on employment litigation. This article looks at some of the consequences that personality disorders may have on employees' work conduct and the role of these disorders in settling employment legal claims.

Public perceptions are that the insanity defense occurs far more commonly than records indicate. In fact, the insanity defense is used in less than 1% of criminal proceedings and is successful in approximately one-quarter of those cases. Furthermore, defendants who are found insane spend as much, or more, time in state custody than their criminally convicted counterparts.

Is the Office of the Inspector General unfairly targeting psychiatrists? The OIG recently reported negative findings for Medicare claims filed by psychiatrists. Will it continue to do so in the study planned for this year?

Jose R. Maldonado, M.D., assistant professor of psychiatry and behavioral sciences at Stanford University, was named the 2001 recipient of the Psychiatric Times Teacher of the Year award. The award was presented to Maldonado at the 14th Annual U.S. Psychiatric & Mental Health Congress in honor of his outstanding achievements in and steadfast dedication to psychiatry. For his work with geriatric psychiatry, Dilip V. Jeste, M.D., has been appointed to the endowed Estelle and Edgar Levi Memorial Chair in Aging at University of California, San Diego (UCSD). Jeste is founder and chief of UCSD's division of geriatric psychiatry and Founding President of the International College of Geriatric Psychoneuropharmacology. He focuses his research on schizophrenia and other psychotic disorders in late life and their successful treatment with the use of safer and more effective drug and psychosocial treatments.Helping people of all ages with schizophrenia to reintegrate into society is the focus of the Eli Lilly and Company-sponsored Reintegration Awards. Recognizing both patient advocates and mental health care professionals, these awards provide grants for their recipients' respective reintegration programs. In the Honorary category, the 2001 "Public Eye Recipient" is Elizabeth Baxter, M.D., a Tennessee-based psychiatrist who, while suffering from psychosis herself, is a mental health advocate on the national level. The 2001 Reintegration Awards were also given in the categories of Advocacy (New Jersey Association for Mental Health Agencies Inc. in Manasquan, N.J.), Clinical Medicine (The Whole Person Family Medicine Clinic in Torrance, Calif.), Education (The Guidance Center Supported Education Program in New Rochelle, N.Y.), Housing (Fred Geilfuss, Scott Reithel, Jack Rosenberg in Milwaukee), Occupational (Restoration Project in Acton, Mass.) and Social Support/Rehabilitation (Fountain House in New York City).

A report released by former Surgeon General David Satcher, M.D., outlines the disparity in mental health diagnoses and treatment between majority and minority ethnic groups. The report also discusses ways of closing the gap in mental health treatment.

When a patient dies and my pager goes off, and a nurse brings in a family member who needs to talk, and my pager cries again, my heart rate jumping to 120, my skin twitching like a racehorse, I hide in a fifth floor bathroom no larger than a closet with an old toilet, rust stained sink, and a mirror the size of my face. I look myself in the eye, to be sure my pupils are equal and react to light, measure my pulse until the beats begin to slow, run cold water on my wrists, stuff paper towels under my arms to absorb the sweat, and make cool compresses to hold on my forehead like a wounded soldier. And I turn off the pager and think about my colleagues, who stand here as alone as me believing no one else knows where they hide.

Many options exist for the pharmacological treatment of anxiety disorders. Are some more appropriate under certain conditions or for some patients? Mechanisms and efficacy of medicinal treatments, as well as some common herbal remedies, are reviewed.

Anxiety disorders are highly prevalent and potentially debilitating psychiatric conditions. Is heredity linked to anxiety disorders? The importance of early identification and management of children at risk for anxiety disorders is emphasized.

Women are more vulnerable to anxiety and depression, which are linked with the development and progression of heart disease. What has been discovered about the specific psychological outcomes for women with heart disease?

Compared with Caucasians, African Americans receive an excess of schizophrenia-spectrum diagnoses. Potential explanations for the ethnic differences in clinical assignment of psychiatric diagnoses are reviewed.

Social anxiety disorder, the third most common mental disorder, is often underdiagnosed and undertreated. A leading expert on SAD provides an overview, including highlights of the barriers to diagnosis, a differential diagnostic approach and treatment options for social anxiety disorder.

A recently published meta-analysis questions if efficacy data garnered from clinical trials is relevant to everyday clinical practice. The authors ponder if enough patients are being included, if they are being followed long enough afterward, and whether exclusion criteria are too broad?

While there is still time before memory begins its long revision, I want to preserve the way you looked the night of my fiftieth birthday when the band played Not Fade Away. You stood with your hand held tight on the center pole of the tent and leaned toward me on stage, your body dying and rocking to the music, your round face creased in that generous smile I always loved, lips curled high at the corners, eyes narrowed to sharpen he focus of your joy.

As the field of addiction psychiatry continues to evolve, researchers and clinicians are looking at old problems with new vision.

Will insurance coverage for mental health care ever equal that of physical health care? Until the federal government takes a stand, many states are implementing new laws or revising old ones to help level the grounds. However, with the states' options ranging from full parity to mandated offering and the option to base coverage on type of mental illness, equal mental health care coverage is still left on shaky grounds.

Psychiatrists are being marginalized in this current era of managed care and treatment teams. What can be done to secure the psychiatrist's role in the diagnosis and treatment of patients?

While progress in identifying the specific genetic variations that help determine an individual's vulnerability to addiction has been slow, a great deal has been uncovered about delineating the role that numerous genes and their protein products play in mediating the development of addiction.

Contingency management provides tangible reinforcement to modify patients' behaviors and has been found to reduce substance abuse across a number of clinical populations and settings. What types of tangible reinforcements are most effective?

Although there are numerous media accounts of the detrimental effects of the drug Ecstasy, there may also be some clinical uses in the treatment of PTSD. The U.S. Food and Drug Administration has approved the first-ever clinical trial of MDMA since it was banned in 1988. An expert in the field discusses what psychiatrists need to know about the popular "rave" drug and the compound's use as a therapeutic tool.

Psychodynamic concepts such as the Self and the collective unconscious are helpful in understanding "our millennial event"3/4Sept. 11, 2001. Because it aims to help patients become aware of and free themselves from social contexts, psychotherapy may be more useful than ever.

Treating traumatized patients requires special care so that both therapist and patient can benefit from the relationship. How can therapists facilitate this care, and what can they do to keep themselves healthy while treating such patients?