Addiction & Substance Use

Concern is on the rise about psychotropic medications-especially atypical antipsychotics-given to foster children covered under Medicaid. Two state Medicaid officials and a representative of the American Academy of Pediatrics (AAP) spoke at hearings of the House Ways and Means Subcommittee on Income Security and Family Support on May 8. Rep Jim McDermott, MD (D, Washington), the only psychiatrist in Congress, has introduced legislation that requires states to improve care coordination for foster children.

News accounts and court records of detainee interrogations in such settings as the Guantnamo Bay detainment camp and the Abu Ghraib prison have sparked controversy over involvement of mental health professionals and behavioral scientists. Authors of articles in medical, psychological, legal, and scientific journals have struggled with complex ethical questions about psychiatrists and psychologists who participate in planning or implementing detainee interrogations.

In the era of genomics, psychiatry-like all areas of medicine-will likely undergo radical change. As genetic risk factors are uncovered and the dynamic nature of gene expression is elucidated, novel approaches to prevention will diminish or preempt diagnosis and treatment for many psychiatric and neurobehavioral disorders.

Two new studies of antipsychotic efficacy for nonpsychotic behaviors in persons with developmental disability provide data where there has been relatively little, but their contrary findings leave this a controversial use of medication.

Aristotle's concept of the incontinent will and Augustine's concept of the captive will.

The practice of one human being helping another to feel better through the use of talk is as old as humanity itself. As a profession, however, psychiatry has existed for only 100 years.

In working with adolescents, mental health care professionals often draw on their own developmental experiences to help guide their patients; however, nonsuicidal self-injury (NSSI) is not likely to be a personal experience that psychiatrists can often draw on.

Addiction-related prevention, research, and treatment have remained important areas of concentration in the field of psychiatry.

The brutal murder of New York psychologist Kathryn Faughey and attempted murder of psychiatrist Kent Shinbach this past February has provoked warnings to psychiatrists about personal safety and overreliance on clinical judgment. David Tarloff, a person with schizophrenia, was indicted for the attacks. According to press reports, Tarloff blamed Shinbach for having him institutionalized in 1991. While he was wait-ing to see Shinbach, Tarloff allegedly entered Faughey's nearby office and slashed her to death with a meat cleaver and knives. Shinbach heard her screams, tried to rescue her, and was assaulted and robbed.

Mr A was desperate. He was about to lose yet another job, not because he was at risk for being fired, but because his lying behavior had finally boxed him into a corner. He had lied repeatedly to his colleagues, telling them that he had an incurable disease and was receiving palliative treatment. . .

Everyone is unique at the level of social, cultural, psychological, biological, and possibly "energetic" functioning. By extension, in every person, the complex causes or meanings of symptoms are uniquely determined. The diversity and complexity of factors that contribute to mental illness often make it difficult to accurately assess the underlying causes of symptoms and to identify treatments that most effectively address them.

The mind-brain dichotomy has been on a roller-coaster ride over the past few hundred years. Clinically astute European neuropsychiatrists in the 18th and 19th centuries described various neuropsychiatric disorders based on observations of their patients.

Psychiatry is changing so rapidly that it seems impossible to predict 1 year ahead, let alone 10 years. In 1967, when my psychiatry training ended, the community psychiatry movement had just begun, DSM-II was in the works, and the biological revolution was still around the corner.

Despite an abundance of studies linking both traumatic experiences and anxiety disorders with eating disorders, relatively little has been reported on the prevalence of associated posttraumatic stress disorder (PTSD) or partial PTSD in patients with eating disorders.

When historians try to understand why psychiatric diagnosis abandoned validity for the sake of reliability in the years surrounding the millennium, they will rely on The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder.

Considering that the brain is increasingly being credited with having a role in everything we think, feel, and do, it was probably just a matter of time before it was postulated that religious belief has a neural substrate.

Maintaining abstinence from alcohol "one day at a time" may be easier with appropriate treatment, but even with the best treatment it can become more difficult as the days add up.

Bulimia nervosa is a disorder with a complex cause. The disorder is most commonly seen in women, generally with onset in adolescence.

A syndrome described as purging following the ingestion of normal or small amounts of food in normal-weight persons has gained increasing attention in the field of eating disorders. Various terms have been used in the literature for this newly characterized syndrome, with purging disorder and eating disorder not otherwise specified-purging (only), or EDNOS-P, used most frequently.

Patients' beliefs about antidepressant drugs are a key factor driving adherence to therapy. According to a recent study, beliefs about efficacy and adverse effects, along with demographic attributes, are among the factors affecting antidepressant adherence.

Although several antimanic agents are available to treat individuals with bipolar disorder (BD), many patients have a less than satisfactory response or experience adverse effects.1 With the exception of lithium, all of the current antimanic agents are either anticonvulsant or antipsychotic drugs. It is remarkable that no drug has been developed specifically for BD, especially because this illness was conceptualized more than a century ago.

Suicide is a devastating, tragically frequent outcome for persons with varying psychiatric conditions, including schizophrenia. An estimated 5% to 10% of persons with schizophrenia commit suicide and 20% to 50% attempt suicide during their lifetime.1,2 Patients with schizophrenia have more than an 8-fold increased risk of completing suicide (based on the standardized mortality ratio) than the general population.3

The cultural and demographic profile of the United States is undergoing a rapid transformation. In many areas of the country, there is no longer an ethnic majority but a multiplicity of racial and cultural groups.

The 1994 death of Nicole Brown Simpson and the subsequent highly publicized murder trial of her ex-husband, O.J. Simpson, brought increasing national attention to the problems of domestic violence and intimate partner murder. In 2000, there were 1247 female victims of intimate partner murder in the United States.1 Fully one third of female murder victims were killed by an intimate partner.1 On the positive side, rates of female victimization by intimate partner violence and murder appear to have decreased in the recent past.

"Jack" has been in our emergency department at least 100 times in the 4 years I have worked at the Veterans Affairs Hospital. I first encountered him in the medical ICU, where he was hospitalized multiple times with chest pain and ECG changes after cocaine binges.

An international team of experts recently proposed expanding the diagnostic criteria for several subtypes of bipolar disorder, adding a pediatric bipolar disorder category and eliminating the schizoaffective disorder category.

Over the past 2 years, I have struggled with my dual role as a resident and a mother. My husband and I moved to the United States in 2002 with high hopes and expectations.

Evidence-based medicine (EBM) is rapidly becoming the norm. It is taught in medical schools and is encouraged by both government agencies and insurance plan providers. Yet, there is little proof that this model can be adapted to fit psychiatry.

In 2006, substance dependence or abuse was diagnosed in about 22.6 million persons in the United States.1 Addiction-related morbidity and mortality pose a major burden to society, costing our economy more than $500 billion annually: about $181 billion for illicit drugs,2 $168 billion for tobacco,3 and $185 billion for alcohol.4

In the historical context of American psychiatry, the concept of boundaries is a relatively recent development.1 Freud reportedly analyzed some patients while walking along the river Danube, gave patients gifts, and was known to share a meal with a patient.