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Psychological testimony is required in more than half the civil trials that unfold each year in the nation's courtrooms, and it is a rare criminal case that doesn't include a psychiatric evaluation during some stage of the proceedings. Yet despite the significant number of interactions between lawyers and forensic psychiatric experts that occur daily, there is still a fault line that separates them.

When do therapists legally owe a duty of care to persons other than their patients? It is an axiom that good medical care involves consideration not only of the patient but also of others. In law, the general principle is that the risk which may result from one's behavior, as reasonably perceived, determines the duty of care.

It is relatively recent that boundary issues in clinical practice have attained professional awareness, although some early concepts portended the issue. Several decades ago, for example, the term boundary violations referred almost exclusively to what we now term sexual misconduct.

Let us begin with an example. Suppose I am traveling from the United States to Switzerland, anticipating skiing with my son in the Alps. My anticipation becomes vivid and lively. I recall excitement mixed with joy at rapidly soaring down the mountainside, and I am now quite anxious to re-experience this thrilling adventure with my son-eager to be heading down the mountain with him. Later, as we stand on the crest of a deep and winding slope, the speed, thrill and admixture of danger and adventure will infuse my being.

Income increased for psychiatrists in 1997, although it dropped for the combined all-physicians category. Dissemination of physician income data became a controversial issue at the AMA House of Delegates meeting last year (Baldwin, 1999; Booth, 1999). Angered by media reports of rising physician income without consideration of hours worked or differences between demographic groups of physicians, delegates voiced concern with the AMA's collection and release of physician income data.

Schizophrenic patients treated with olanzapine (Zyprexa) required less health care services and incurred less overall health care costs over a 28-week period than patients treated with risperidone (Risperdal). This was the result of a study presented by Eli Lilly and Company researchers at the European College of Neuropsychopharmacology meeting held in Paris from Oct. 31, 1998 to Nov. 4, 1998.

Other Hormones on Behavior - Poetry of the Times

One day after Eli Lilly and Company researchers reported finding olanzapine (Zyprexa) superior to risperidone (Risperdal) on some measures in a 28-week comparative study presented to the American College of Neuropsychopharmacology (ACNP) meeting in 1996, Janssen Pharmaceutica Inc. issued a press statement critical of the methodology and results of the study. Janssen then announced it would undertake its own comparative trial. The results of this trial's initial eight-week acute treatment phase were presented at the European College of Neuro-psychopharmacology meeting held Oct. 31, 1998, through Nov. 4, 1998, in Paris. They indicate risperidone has an advantage for positive symptoms such as hallucinations and delusions, and for anxiety/depression in patients with schizophrenia and schizo-affective disorder.

For her work in establishing the Dialectic Behavioral Therapy (DBT) model for use with chronically suicidal individuals suffering from borderline personality disorder (BPD), Marsha M. Linehan, Ph.D., is this year's recipient of the annual research award given by the New York City-based American Foundation for Suicide Prevention (AFSP).

Proposed in December 1998, the merger has turned Aetna into a managed care powerhouse providing coverage for about one in 11 Americans and having contracts with some 400,000 physicians, more than half the national total. This concentration of economic power, opponents charge, will substitute profit-driven "minimally acceptable clinical guidelines" for treatment plans determined by physicians operating in their patients' best interests. Mental Health Threatened by Aetna/Prudential Merger

Ownership of the human genome-or, more exactly, access to the tools and databases necessary to make sense out of the millions of bits of information that make up the estimated 100,000 human genes-constitutes one of the hottest scientific debates in the public policy arena. On one hand is the Human Genome Project (HGP), a worldwide consortium of governments and their supported researchers who are mapping the 23 pairs of human chromosomes and are determining the complete nucleotide sequence, involving 3 billion base pairs of DNA.

The benefits of psychotherapy in treating the chronically suicidal patient, as well as strategies that can help the potential suicide patient imagine and reflect others' reactions to this most final of acts, was the subject of a conference by Glen O. Gabbard, M.D., at the 11th Annual U.S. Psychiatric & Mental Health Congress. Gabbard is the Bessie Callaway Distinguished Professor of Psychoanalysis and Education at the Karl Menninger School of Psychiatry and Mental Health Sciences.

Whenever a Stanley Kubrick film opens, it is an event. Kubrick, who is considered by many the cinematic genius of the 20th century, made 15 feature films. The eager anticipation surrounding his last film "Eyes Wide Shut," scheduled to be released this summer, has intensified even further because of Kubrick's unexpected death last March at the age of 70. Although the film is shrouded in standard Kubrickian secrecy, leaks suggest that Tom Cruise and Nicole Kidman play psychotherapists who are sexually involved with their patients.

Tina, a 35-year-old legal secretary, is admitted to the hospital hearing voices that demand she gouge out her own eyes as punishment for having lived a sinful life. She was seen in the local emergency room prior to admission, both for involuntary certification and treatment for corneal damage from having attempted to harm herself. She states to the admitting psychiatrist, "If thine eye offend thee, pluck it out!"

Postcard from Auschwitz - Poetry of the Times

For her work in establishing the Dialectic Behavioral Therapy (DBT) model for use with chronically suicidal individuals suffering from borderline personality disorder (BPD), Marsha M. Linehan, Ph.D., is this year's recipient of the annual research award given by the New York City-based American Foundation for Suicide Prevention (AFSP). Linehan is professor of psychology and adjunct professor of psychiatry and behavioral sciences at the University of Washington.

This article addresses several important theoretical issues related to dynamically oriented psychotherapy. These issues include the therapeutic alliance and transference, the authority of the therapist and neutrality, the stability of the therapeutic environment, countertransference, empathy, and basic strategy. Efforts are made to present these issues in a contemporary context.

Psychiatry residents want and need solid training in psychotherapy in order to best serve their patients and to remain competitive in the mental health marketplace, concluded a March conference sponsored by the American Psychiatric Association's Commission on Psychotherapy by Psychiatrists (COPP). The event, entitled "Integration and Specificity in Psychotherapy Education," drew 120 training directors, residents and faculty from around the country, and represented approximately 40% of U.S. residency training programs.

Until the last half of this century, there were few if any treatments that seemed consistently effective in responding to the clinical needs of individuals who were abusing or dependent upon alcohol. As a result, support or self-help groups emerged. Alcoholics Anonymous is an extraordinary example of these groups.

Even the threat of criminal prosecution didn't dissuade CBS from broadcasting a "60 Minutes II" investigation called "Unsafe Haven," an hour-long report that chronicled alleged abuses committed "in more than 20 Charter Hospitals." A last-minute effort by Charter Behavioral Health Systems, the nation's largest provider of inpatient mental health services, to obtain an injunction against the April airing failed, but not without the judge in the case taking some legal swipes at CBS.

Crossing the Street - Poetry of the Times

In this incredible era of breakthroughs in neuroscience and its applied therapies, psychiatrists have been recognized as leaders and pioneers in battling the previously elusive maladies of the human condition. In the darkness, people instinctively follow the person carrying the lantern. As a consequence, I am not necessarily sure where we're going.

Although the exact etiology of premenstrual syndrome (PMS) remains unknown, it appears to be a chronic mood disorder that continues for many years in reproductive-age women. Approximately 2% to 10% of cycling women report severe symptoms resulting in a disruption of work or relationships.

Only one month after the American Medical Association unveiled a major reorganization of its science and technology departments-one that included the dismantling of its department of mental health-the former director, psychiatrist Larry Goldman, M.D., was fired after he criticized the changes.

Recent advances in the treatment of mental and addictive disorders, along with research findings in basic neuroscience, molecular genetics and molecular biology that contribute to the understanding of such disorders, were discussed at the American College of Neuropsychopharmacology's 37th annual meeting in Puerto Rico. The following are brief reports from selected presentations.

According to one estimate, 42,000 of the 757,000 practicing physicians in the United States-roughly 5.5%-were members of a union by the middle of last year. That number appears to have grown. The union movement is sweeping the medical profession around the country.

More than 80 medications are in development to treat mental illnesses, including 18 for depression, 15 for schizophrenia and 16 for anxiety disorders, according to the Pharmaceutical Researchers and Manufacturers of America (1998). Which ones will most likely come to market in the United States?

Psychogenic excoriation (also called neurotic excoriation, pathologic or compulsive skin picking, and dermatotillomania) is not yet recognized as a symptom of a distinct DSM-IV disorder.

Without clear guidance from government regulators, mistakes are easy to make and, rather than raising concerns in a businesslike fashion, the first notification of a problem often comes when the enforcement action shows up at the door.

Rough Air