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For decades, physicians have railed against the inequities of malpractice laws, lobbying for statutory changes that would insulate them from injustices, both real and perceived. In an ironic twist, extending tort liability has become the latest weapon against managed care companies and the medical directors who often make utilization review determinations. As a result, managed care companies are now rushing to embrace the once scorned external review and independent appeals processes in a last-ditch effort to stave off reforms requiring them to justify health care decisions in front of judges and juries.

As psychological and mental health issues increasingly take center stage in high profile criminal and civil proceedings, the ability to satiate inquiring minds often means trashing privacy and confidentiality at the altar of the public's right to know. Tyson isn't the only one whose psychological profile has been splayed out before an audience of billions in cyberspace.

When treating agitation in the elderly, the optimization of certain behavioral techniques may enhance medication therapies or sometimes eliminate the need for them. Clinicians should look more closely at the behavioral causes behind a demented older person's problem behavior.

Aware that there is a "rush to hold all providers delivering mental health and chemical dependency services accountable for the accessibility, quality and satisfaction of such services," the American Managed Behavioral Healthcare Association (AMBHA) recently released the second version of its Performance Measures for Managed Behavioral Healthcare Programs (PERMS 2.0).

In Western psychiatry, depression is considered a major cause of suicide. But research from China calls that assumption into question. More than 300,000 suicides occur annually in China, nearly 10 times the number of suicides in the United States.

The National Household Survey on Drug Abuse (NHSDA), the primary source of statistical information on Americans' use of alcohol, tobacco and illicit drugs, will be expanded in upcoming years to include substantial information on mental illness and state-level data on drug abuse, according to Nelba Chavez, Ph.D., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA).

Verdicts in separate malpractice cases have heightened apprehension over the erosion of patient-physician confidentiality and the increase in malpractice liability exposure. Psychiatrists now face the more serious prospect that they could end up, in essence, having to guarantee society that their patients won't act dangerously.

Meeting the mental health needs of the millions of immigrants from diverse cultural backgrounds and homelands who now live in the United States may require more than a thorough knowledge of psychiatry or psychology, according to a number of cultural psychiatric practitioners.

What I Love (after Stephen Dunn) - Poetry of the Times

Consider the following scenario: You are contacted by the major health plan with which you contract and are told that your average length of inpatient stay is longer than their standard. You believe this is because your patients are more severely ill than average. How do you respond?

The term managed care has become the new blasphemy in the health care industry. Symposia, lectures and other presentations on this topic at the 1997 American Psychiatric Association convention all seemed to conclude that managed care in any form is evil and unethical and that by maintaining the moral high ground, physicians holding out against managed care would ultimately win because the cause is just.

Insufficient intake of essential fatty acids (EFAs) may contribute to the pathogenesis of mental diseases, while their supplementation may relieve some symptoms, according to researchers who attended the National Institutes of Health (NIH) Workshop on Omega-3 Essential Fatty Acids and Psychiatric Disorders held in Bethesda, Md., in September 1998.

This is the second of two articles regarding herbal medicines as discussed at the American Psychiatric Association's annual meeting in Toronto. Potential benefits and risks of kava, St. John's wort and hoasca were considered at the recent American Psychiatric Association's symposium on herbal medicine.

While managed care generally has limited inpatient care and contained short-term costs for mental health and substance abuse services, significant questions remain about how these changes in health care delivery affect the quality of care patients receive.

To understand how mental health law is changing, one must begin with a sense of its traditional orientation. The underlying principle of the law that governs psychiatric practice has been that patients require protection from unjustified restrictions on their liberty, especially at the hands of the state.

Meeting the mental health needs of the millions of immigrants from diverse cultural backgrounds and homelands who now live in the United States may require more than a thorough knowledge of psychiatry or psychology, according to a number of cultural psychiatric practitioners.

The advent of the new millennium has stimulated many discussions about what changes can-and should-occur in the world. For social psychiatry, there could not be a more fortuitous time to review and reaffirm our role in this country's health care.

Breaking the News - Poetry of the Times

The passage of the Mental Health Parity Act of 1996, which took effect Jan. 1, 1998, came amid dire warnings from edgy business groups that it would cause exorbitant cost increases in health insurance premiums or prompt a dramatic reduction of medical and surgical benefits. But a recently released report emphasized the affordability of mental health insurance coverage.

This month establishes a milestone for CME LLC Not only is it the company's 11th annual U.S. Psychiatric & Mental Health Congress, it also marks the 20th anniversary of the company's first conference. CME LLC grew out of a desire to reach and educate more people regarding psychiatric issues. One way to do this was by developing high-quality continuing education opportunities.

Apology - Poetry of the Times

The Health Care Financing Administration (HCFA), the agency responsible for administering the burgeoning Medicare program for the elderly, announced a nationwide crackdown on community mental health care centers (CMHCs) in September, signaling increased efforts to curtail fraud, error and abuse.

The dynamically informed psychotherapies can be thought to occur on a continuum, with the most insight-oriented and exploratory types at one end and the most supportive types at the other. Psychoanalysis proper stands at the end of this continuum, followed by analytically oriented psychotherapy, then dynamically oriented psychotherapy. Within this classification, analytical oriented psychotherapy and dynamic oriented psychotherapy are two quite distinct, yet related, forms of therapy.

Organ donation from brain-dead patients has become a psychiatric issue in Japanese transplant medicine. Brain death is recognized as human death only in the context of organ transplantation in Japan. Since many Japanese physicians deny that brain death constitutes the death of an individual, there is no solid, general consensus in Japan about what constitutes brain death.

The poet must remember that it is his poetry which bears the guilt for the vulgar prose of life, whereas the man of everyday life ought to know that the fruitlessness of art is due to his willingness to be unexacting and to the unseriousness of the concerns to his life. The individual must be answerable through and through: all of his constituent moments must not only fit next to each other in the temporal sequence of his life, but must also interpenetrate each other in the unity of guilt and answerability-M.M. Bakhtin, 1919

An investigational compound that blocks the neurokinin "substance P" has demonstrated robust antidepressant effect in preliminary clinical testing against paroxetine (Paxil) and placebo. This finding has been described by as "a breakthrough discovery" in mental health care.

Only in recent years has the widening scope of domestic violence achieved such national prominence. Highly publicized cases like the Nicole Brown Simpson murder have brought the issue of domestic violence to worldwide attention. Overall rates of violence against women, including both lethal and nonlethal violence, are much higher.

Psychotherapy as a sole treatment for noncoerced opioid addicts in outpatient settings has been shown to have little patient interest and low chances for success. However, when integrated into a treatment plan that includes methadone maintenance and drug counseling, it can be associated with additional benefits for patients who have moderate to severe levels of psychiatric symptoms.

In view of the fact that support is an important aspect of all models of psychotherapy, it is remarkable that beginning practitioners are not taught how to be supportive. Only limited attention has been paid to discussion of the principles underlying supportive interactions. It seems to be taken for granted that good sense, kindness, innate empathy and life experience will enable psychotherapists-and physicians in general-to meet their patients' needs for support by communicating interest, liking and understanding. Just as the literature on psychoanalysis is a source for much of what we know about the expressive component of therapy, the limited literature on supportive psychotherapy is a source for ideas pertinent to the supportive component.

A popular slang definition of the verb to split is "to depart," or "to leave." In this context, to split describes the occasional wish of a psychiatrist who may be mired in the chaos created by the behavior of a patient diagnosed with borderline personality disorder. The primary definition of to split is "to divide sharply or cleanly."