July 11th 2024
What is new in research on alcohol use disorder?
Southern California Psychiatry Conference
September 13-14, 2024
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Updates on New and Emerging Therapies to Improve Outcomes for Patients With Major Depressive Disorder
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PER® Psychiatry Summit
November 7, 2024
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5th Annual International Congress on the Future of Neurology®
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2023 Annual Psychiatric Times™ World CME Conference
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Clinical Consultations™: Managing Depressive Episodes in Patients with Bipolar Disorder Type II
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Patient, Provider, and Caregiver Connection™: Exploring Unmet Needs In Postpartum Depression – Making the Case for Early Detection and Novel Treatments
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Medical Crossfire®: Understanding the Advances in Bipolar Disease Treatment—A Comprehensive Look at Treatment Selection Strategies
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'REEL’ Time Patient Counseling: The Diagnostic and Treatment Journey for Patients With Bipolar Disorder Type II – From Primary to Specialty Care
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Real Psychiatry 2025
January 17 - 18, 2025
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More Than ‘Blue’ After Birth: Managing Diagnosis and Treatment of Post-Partum Depression
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Patient, Provider & Caregiver Connection™: Reducing the Burden of Parkinson Disease Psychosis with Personalized Management Plans
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Expert Perspectives in the Recognition and Management of Postpartum Depression
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There were only 3 Jewish students in my high school, and I was one of them. In the small, western New York town where I grew up, most people were tolerant. But a small clique of anti-Semites made life tough for us Jewish kids. Most of the time, we just shrugged off the jokes and insults or came right back at these louts with a snappy retort. Sometimes, the bigotry grew more menacing.
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Hoarding: Studies Characterize Phenotype, Demonstrate Treatment Efficacy
May 1st 2007A 79-year-old woman recently died in a fire at her Washington, DC, row house when "pack rat conditions" prevented firefighters from reaching her in time. A few days later, 47 firefighters from 4 cities spent 2 hours fighting a fire in a Southern California home before they were able to bring it under control. Floor-to-ceiling clutter had made it nearly impossible for them to enter the house.
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The Joker and the Thief: Persistent Malingering as a Specific Type of Therapeutic Impasse
May 1st 2007"There must be some way out of here," said the joker to the thief."There's too much confusion, I can't get no relief. . . .""No reason to get excited," the thief, he kindly spoke,"There are many here among us who feel that life is but a joke.But you and I, we've been through that, and this is not our fate,So let us not talk falsely now, the hour is getting late."From "All Along the Watchtower," Bob Dylan
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Functional Analysis of Malingering in the Emergency Department
May 1st 2007In The Perfect Storm, Sebastian Junger describes the desperate plight of sailors and fisherman who, in the fall of 1991, were caught out in the Atlantic Ocean as 2 powerful storms converged into 1.1 Like those mariners, emergency department (ED) clinicians find themselves at the confluence of 2 powerful trends in modern society.
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Recognition of Dopamine in Sleep-Wake Function May Improve PD Care
May 1st 2007aytime sleepiness is common in patients with parkinsonism but has little to do with the amount of sleep these patients get and everything to do with dopaminergic dysfunction, according to David B. Rye, MD, PhD, associate professor of neurology at Emory University in Atlanta. "The idea is that if I sleep a lot, I shouldn't be so sleepy the next day, and if I sleep little, I should be very sleepy. This is doesn't hold true for patients with Parkinson disease [PD]. The loss of dopamine disrupts that banking system, or the sleep-wake homeostat," he said during a presentation at the 9th annual meeting of the American Society for Experimental Therapeutics, which met March 8 to 10 in Washington, DC. Addressing dopa- minergic tone during sleep might help ameliorate daytime symptoms of parkinsonism in general.
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Well-Designed Aphasia Therapy Works
May 1st 2007Intensive therapy over short periods provides better outcomes than less intensive regimens performed over longer periods." This was the take-home message about rehabilitation for patients with aphasia from Ronald M. Lazar, PhD, professor of clinical neuropsychology in neurology and neurological surgery, and codirector of the Levine Cerebral Localization Laboratory at the Neurological Institute of New York at Columbia University College of Physicians and Surgeons.
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Malingering in Acute Care Settings
May 1st 2007The role of every emergency clinician is to determine whether the patient has a condition that threatens life or limb. Determining this in patients who malinger can be quite a challenge, because the malingering patient presents with false or exaggerated symptoms for secondary gain.
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USPSYCH: Concurrent Treatment Works for Comorbid ADHD and Substance Abuse
April 25th 2007SAN FRANCISCO -- Given the high prevalence of substance abuse in patients with attention deficit hyperactivity disorder (ADHD), psychiatrists need to consider comorbidity in assessment of both conditions.
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The Suicidal Patient: Risk Assessment, Management, and Documentation
April 15th 2007Suicide is a serious public health problem that ranks as the 11th leading cause of death in the United States. Within the 15- to 24-year-old age group, it is the third leading cause of death.1 Many suicide victims have had contact with the mental health system before they died, and almost one fifth had been psychiatrically hospitalized in the year before completing suicide. A recent review found that psychiatric illness is a major contributing factor to suicide, and more than 90% of suicide victims have a DSM-IV diagnosis.
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Reducing the Risk of Addiction to Prescribed Medications
April 15th 2007Physicians are often conflicted regarding prescription medications for pain, especially pain complicated by insomnia and anxiety. Concerns that patients may become addicted to medications, exacerbated by limited time available to get to know patients, can lead to underprescribing of needed medications, patient suffering, and needless surgery. At the other extreme, pressure to alleviate patients' distress can lead to overprescribing, needless side effects, and even addiction.
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Functional MRI as a Lie Detector
April 15th 2007In the past few years, a great deal of information has been learned about how the brain processes ambiguous information. Data exist that allow us to view what the brain looks like when we are deliberately trying to deceive someone. In response, a number of corporations have been established that use these data--and the imaging technologies that gave them to us--to create brain-based lie detectors.
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Psychiatric Malpractice: Basic Issues in Evolving Contexts
April 15th 2007This article focuses on 4 issues in psychiatric malpractice: prescribing, liability for suicide, informed consent, and duty to protect under the Tarasoff v Regents of the University of California ruling. Malpractice is a civil wrong actionable by law. There are 2 goals of malpractice suits: the first is to make an injured plaintiff whole by an award of money, and the second is to inform the profession how courts will decide similar cases in the future.
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Paraphilias: Clinical and Forensic Considerations
April 15th 2007Paraphilias are defined by DSM-IV-TR as sexual disorders characterized by "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving (1) nonhuman objects, (2) the suffering or humiliation of oneself or one's partner, or (3) children or other nonconsenting persons that occur over a period of 6 months" (Criterion A), which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (Criterion B). DSM-IV-TR describes 8 specific disorders of this type (exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism, and transvestic fetishism) along with a ninth residual category, paraphilia not otherwise specified (NOS).
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The Changing Face of Alcoholism Treatment
April 1st 2007At the core of alcoholism is the pathologically increased motivation to consume alcohol at the expense of natural rewards with disregard for adverse consequences. naltrexone and acamprosate represent the first generation of modern pharmacotherapies that target this pathology.
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The Religion of Benzodiazepines
April 1st 2007Several months ago, a new psychiatrist came from a prestigious university in the Northeast to work in the VA hospital out West where I practice. During one of our initial conversations, he expressed the emphatic view that "benzodiazepines are only useful for acute alcohol withdrawal or psychiatric emergencies and other than that they have no place in pharmacology." I juxtaposed this position with that of several of our older clinicians, who are equally strong advocates of the generous use of benzodiazepines for a variety of psychiatric symptoms.
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Understanding Medication Discontinuation in Depression
April 1st 2007Compared with schizophrenia, adherence behavior has been relatively overlooked in depression and other mood disorders. Major depression is increasingly thought of as a chronic illness. In most chronic illnesses, ideal concordance is the exception, not the rule.
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A Precautionary Tale in Psychiatry
April 1st 2007Over the past 50 years, psychiatry has increasingly become psychiatric medicine coincident with the enormous developments in our understanding of and ability to effectively use clinical psychopharmacology to treat patients with psychiatric illnesses. There have been both increased understanding of the molecular mechanisms underlying the effects of psychiatric medications and increased numbers of psychiatric medications. The latter has occurred in tandem with a similar explosion in the availability of medications to treat a host of other medical conditions. In fact, the repertoire of available medications expands virtually every few weeks.
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When friends and family need medical advice, they often consult me even though I'm nothing more than a medical news writer. Folks think it is worthwhile to tell me rather than a real medical professional about the curious pain that occasionally shoots through their leg or their heart or their head. They ask my advice about what new intervention they might try for a chronic condition or whether they really need to get that prescribed vaccine or take those antimicrobials before going off to Madagascar or some such place.
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Mental Illness on the Screen: No More Snake Pit
April 1st 2007Just 2 minutes before an episode of the television show Boston Legal aired, Roger Pitman, MD, professor of psychiatry at Harvard Medical School, received a telephone call from his sister-in-law informing him that the show would include a segment on propranolol, a drug he was researching for the prevention and treatment of PTSD.
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Lifetime Psychiatric Comorbidity of Illicit Drug Use Disorders
April 1st 2007What is comorbidity? Psychiatric comorbidity refers to the occurrence of 2 or more mental or substance use disorders within a certain period. Research shows that comorbidity of substance use and other psychiatric disorders is common and often worsens the prognosis for each disorder.
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FDA Tries to Bridge Data Divide With New Antidepressant Warnings
March 3rd 2007The FDA finds itself straddling a data divide as it decides how to rewrite the black box warnings on the labels of SSRI antidepressants. The agency will almost certainly mandate that the existing black box warning, which addresses suicidality in children and adolescents, be expanded to include young adults up to age 25 or 30. But in what might be a pioneering move for the FDA, the agency will probably also include new verbiage in the warning related to the benefits of antidepressants to people over the age of 30 years.
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This month, I decided that the time had finally come the time to throw out the 4 boxes I had stored in my attic since leaving my childhood home. These boxes lay piled in a corner with 30 years of dust and dirt on their lids. Unopened in all these years, they were filled with things I didn't need or miss. But before tossing them out, I decided to take a look inside.
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Mental Health Drugs at Issue in Part D Debate
March 1st 2007The price and availability of psychiatric drugs is expected to be one of the major issues as Congress decides whether to try to find a way to force pharmaceutical manufacturers to lower the prices they charge Medicare Part D drug plans. Antidepressants, antipsychotics, and anticonvulsants are among the 6 categories for which Part D formularies must make available "all or substantially all" medications. As a result, the formularies are unable to bring to bear the drug price reduction strategies they use in other categories.
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When I was young and attended church services with the family, the sermons of a certain priest, who was a historian, consisted of anecdotes about desperation and compassion that occurred in such places as Nazi concentration camps, Hell's Kitchen or the Bowery in Depression-era New York, or Dickens-like orphanages somewhere. At the end of his anecdote, the priest would dolefully lilt, Examine your own conscience. It was the point during the sermon when a person might startle awake after nodding off.
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The Clinical Management of Amyotrophic Lateral Sclerosis
March 1st 2007Amyotrophic lateral sclerosis (ALS) is a progressive, debilitating, fatal disease that involves degeneration of upper and lower motor neurons. Patients often initially present with limb or bulbar weakness, atrophy, and spasticity, followed by progressive loss of ambulation and, ultimately, respiratory failure, which is the most common cause of death.
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Stroke Complications: Hiding in Plain Sight?
March 1st 2007Despite the enormous progress made in stroke diagnosis and treatment in recent years, patients continue to experience stroke-related deficits that clinicians-even those working on stroke rehabilitation units-do not always recognize or record. In a recent study of 53 patients who underwent screening tests within 10 days of admission to a stroke unit, every impaired patient had at least 1 undocumented cognitive or sensory deficit. The authors suggested that without formal testing with standardized assessments, much stroke-related impairment goes unrecognized and perhaps untreated.
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