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There is and has been much debate about the issue of assisted suicide as physicians, lawyers and lay people argue the pros and cons of assisting in someone's death. The physician who agrees to participate in this endeavor points out that his or her concern is to alleviate suffering. Notwithstanding that, painkillers are notoriously prescribed in inadequate, understrength doses; people with serious illness who are depressed are considered unlikely candidates for treatment of their depression because, sayeth the physician: "It is only natural, understandable, to be depressed with that kind of terrible illness."

On the surface, mental health parity does not appear to be controversial. Why should insurance companies and government insurance discriminate against patients with psychiatric problems? Making an artificial separation between psychiatric and medical illness makes little clinical sense. It is also clear that the treatment of psychiatric disorders often decreases physical symptoms, resulting in fewer visits to nonpsychiatric physicians. Cost estimates for mandating parity, although widely divergent, have generally been thought to be low. However, many seemingly benign regulations can often result in unforeseen costs and negative effects.

For elders confronted with the necessity of living in a nursing home, the choice of facility is a decision with profound consequences-for their health, their quality of life and their family finances. Nursing home care may cost $50,000 a year or even more, and more than half of all elders begin their nursing home stays by paying the costs out of pocket. That imposing sum can purchase excellent care, or can pay the rent for a place that is literally "worse than death" for the unfortunates who live there.

A lawsuit brought on behalf of the 600,000-member United Seniors Association (USA) and four individual Medicare recipients last December may turn the Washington, D.C., federal court where it was filed into the latest health care battleground. The issue: Does a patient's right to choose a physician outweigh the federal government's efforts to regulate health care provided to the elderly?

The ERISA shield has become a favorite of employers and benefits providers, because its overwhelming effect is to reduce the situations in which they can be held legally responsible for misdeeds. Even in cases where a violation can be established, the statutory penalties are insufficient to make bringing cases to court worthwhile, or are inadequate to deter future improper conduct. Efforts over the years to enact an amendment to ERISA have failed because of powerful lobbying by business and health care interests. re reluctant to utilize, inform or confront their care providers, impairing collaboration in treatment.

This year at the 10th Annual U.S. Psychiatric & Mental Congress, CME LLC honored deserving recipients with the prestigious "Lifetime Achievement Award." The award winners for 1997 were recognized during a presentation ceremony in Orlando, Fla., in November.

Every evening, just when quiet comes, she awakens on the prowl.

It is estimated that 60% to 70% of American people who have health insurance have a plan which falls under the provisions of the Employee Retirement Insurance Security Act of 1974 (ERISA). ERISA was designed to protect and enhance pensions and benefits for employees of nationwide companies, and was heavily lobbied for by business as more and more employers established facilities in multiple states.

Depression, subcortical dementia and normal aging: all three may have similar neurobehavioral manifestations. So how does a clinician make a differential diagnosis?

Recent headlines in national newspapers declaring that mentally ill patients are often denied care by psychiatric hospitals merely confirmed what most psychiatrists have known for years. A study published last December, however, created a stir when the authors released what they called "the first national analysis of the factors that promote or constrain economically motivated transfers of patients in relation to competitive pressures, hospital ownership, and managed care practices."

Death Sentence, Ethics, Psychiatry, Competency, Execution, Prisoner, Psychiatrists

Approval of the nation's first physician-assisted suicide law last November has proved the adage "be careful what you wish for." In the aftermath of the Oregon initiative that once again endorsed the state's Death with Dignity Act, physicians and government officials throughout the country are now scrambling to make sense of the law and figure out ways to assure that compliance doesn't lead to liability, both criminal and civil.

January Thaw - Poetry of the Times

In its 1986 decision in Ford v. Wainwright, the U.S. Supreme Court found that death row prisoners had a constitutional right not to be executed if they were incompetent (477 U.S. 399 [1986]). Competence for execution-an odd concept, but one whose roots go back to biblical times-usually requires that a prisoner understand the nature of the punishment about to be imposed and why it is being imposed.

In its 1986 decision in Ford v. Wainwright, the U.S. Supreme Court found that death row prisoners had a constitutional right not to be executed if they were incompetent (477 U.S. 399 [1986]). Competence for execution-an odd concept, but one whose roots go back to biblical times-usually requires that a prisoner understand the nature of the punishment about to be imposed and why it is being imposed.

For 17 years, claim federal prosecutors, Theodore Kaczynski terrorized the nation with a string of 16 bombings that killed three people and injured 23 more. On trial now for his life, the alleged Unabomber's case will most likely hinge on the expert testimony proffered by a covey of psychiatrists and psychologists scheduled to be called as witnesses as the case unfolds in U.S. District Court in Sacramento, Calif. this month.

The Association of Gay and Lesbian Psychiatrists (AGLP) is a professional organization of psychiatrists, residents, medical students and supporters, which serves as a voice for the concerns of lesbians and gay men in the professional psychiatric community. AGLP is committed to fostering a more accurate understanding of homosexuality, ensuring well-informed and appropriate treatment for lesbians and gay men, and opposing discriminatory practices against gays and lesbians in our society.

"Hwa-byung" and "ataque de nervios," listed in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) as culture-bound syndromes, can serve as gateways to understanding anger's role in psychiatric morbidity, according to a panel of experts.

In 1997, the National Library of Medicine (NLM) helped initiate a new era in American medicine when it made MEDLINE, its comprehensive online bibliography of published medical information, accessible to the public through the World Wide Web. That event may prove to be a symbolic watershed of 20th century American medicine. It will impact every aspect of medicine, from the manner in which physicians are educated to the way they run their daily practices.

Scientific, social or legal redefinition is only slowly reflected in changed practitioners and practices. It is not surprising that surveys continue to report high levels of ignorance and prejudice encountered by homosexuals in their contacts with health care providers. This also contributes to a negative feedback loop in which many homosexuals are reluctant to utilize, inform or confront their care providers, impairing collaboration in treatment.

Many of the factors purported to influence accessing mental health services by men and ethnic minorities are systemic in nature, ingrained within our culture, and consequently, difficult to change (e.g., gender differences in attitudes toward help-seeking, ethnic differences in the use of alternative healing resources). However efforts have been made within the mental health system to make services more acceptable to men and minority group members who choose to, or are able to, access the system.

What counts as participation in capital punishment? Is it possible for a medical activity to be ethical in one context, but a similar one not ethical in another? Is death different? Are there neat and universal ethical rules that will always guide us wisely, or are there inevitable clashes among various legitimate and important values? Is it ethically possible that a forensic psychiatrist is not a psychiatrist, as Dr. Paul Appelbaum has argued? How strongly should physicians protect their duty to always help and not harm all individual patients in the face of many pressures to do otherwise?

In its 1986 decision in Ford v. Wainwright, the U.S. Supreme Court found that death row prisoners had a constitutional right not to be executed if they were incompetent (477 U.S. 399 [1986]). Competence for execution-an odd concept, but one whose roots go back to biblical times-usually requires that a prisoner understand the nature of the punishment about to be imposed and why it is being imposed.

Peter Penna, Pharm. D. spoke on the future of drug formularies and how he sees them changing. Formularies in managed care evolved out of formularies in hospitals and have been around since drugs became relatively commonly used in patient settings, Penna explained. "Today, formularies are widely used by hospitals, managed care organizations, pharmacy benefit management companies, home health agencies and nursing home services."

Nelson Kull, executive director of Pathways, sees an additional benefit to consumer employment: it provides patients with a first-hand look inside the system, and this can help defuse the sometimes antagonistic relationship between consumers and caregivers. "Some people criticize doctors and pharmaceutical companies for making a lot of money," says Kull, "but they gave me back my life. I once told meeting [attendees] that yes, psychiatry and medical care cost a lot, but your car costs a lot. I can't drive my car without my medications, so which comes first?"

The stakes in the debate over recovered memories therapy ratcheted upward in October with the indictment of five health care professionals, including two psychiatrists, in Houston. Charged in a 60-count indictment-believed to be the first of its kind in the United States-the former staff members of the now defunct dissociative disorders unit at the Spring Shadows Glen Psychiatric Hospital are accused of perpetrating a "scheme to defraud by allegedly falsely diagnosing patients with multiple personality disorder caused by their alleged participation in a secret satanic cult."

Before the Malpractice Suit - Poetry of the Times

As a consultant and educator for various stakeholders in the delivery of managed mental health services, I see confusion, skepticism and demoralization in the mental health professions about the direction health care is taking. Many doubt their ability to achieve the objective of the managed care mantra: Better care at less cost. To the clinician delivering care, it feels as if there is no stable ground to stand on, or, in the words of a 1960s female R & B group: "Nowhere to run to baby, nowhere to hide." Our profession seems to be either frozen in fear or disorganized in struggle, not grounded and coordinated in response to the changes that are upon us.

There is an increasing body of data that suggests there may be relationship between certain forms of childhood-onset OCD and previous Group A beta-hemolytic streptococcal infections. They seem to have early-onset OCD, tic disorder, Sydenham's chorea and family history of tics. Sydenham's chorea, a major manifestation of rheumatic fever and a disorder generally limited to prepubertal children, is thought to be disease of basal ganglia, and the basal ganglia is thought to be involved in both Sydenham's chorea and OCD. Children with Sydenham's chorea frequently present with OCD symptoms.

In the spring of 1997, legalization of physician-assisted suicide seemed inevitable. In the space of a month, two appellate courts had declared a constitutional right to physician-assisted suicide, overturning long-standing state laws in New York and Washington that prohibited the practice. Many observers expected the U.S. Supreme Court to follow suit. Earlier, Oregon had become the first state to legalize physician-assisted suicide. Although that decision was still being contested in the courts, had the Supreme Court recognized and accepted a constitutional right to physician-assisted suicide, Oregon was ready to become the first state in which it was practiced.