Addiction & Substance Use

With the advent of computer technology, new forms of therapy have emerged that can help patients. How can a virtual reality environment enable patients to overcome panic disorder and agoraphobia, and what are the advantages to such forms of therapy?

One of the more difficult aspects of treating children and adolescents is the issue of aggression. An expert consensus panel convened by the Center for the Advancement of Children's Mental Health at Columbia University and the New York State Office of Mental Health has released a new set of treatment guidelines that should help physicians give the best care possible.

The use of supportive psychotherapy, where the clinician acts as a watchful parent, may be of some use to certain patients as opposed to traditional psychoanalysis. This paper gives some examples of cases in which supportive psychotherapy may be more effective.

Once the potential for violent behavior has been identified in a patient, how should it be dealt with? What steps can the clinician take to ensure the physical and legal safety of themselves and their patients? Furthermore, what are the clinician's legal and ethical responsibilities if the patient does commit a violence act?

Theater, film, literature and poetry are forms of expression that allow artists and their audiences to explore the compelling issues of their lives. By understanding which pieces "speak" to patients and physicians, the dialogue and therapy may be enhanced.

Using music as a form of therapy for emotionally disturbed children seems quite natural, given children's innate love of music. How can this form of creativity be used as therapy to help children better communicate feelings and emotions?

In presenting the subject of dangerousness assessments at my hospital, I told a story about my grandchildren that illustrated the fact that we all make such assessments and act on them regularly in various contexts.

Becoming more creative and improvising have certain dynamics that can be used by therapists in fostering a more healing process. Playfulness, imagination, dialogue, skill-building, narrative, inspiration and integration can all be employed in clinical settings. These tools create an environment where spontaneity can arise, anxiety is reduced, and patients are more receptive to their own intuition.

Proponents of mental health care parity have reintroduced the legislation that died in the U.S. House of Representatives last year. While the idea of parity has broad bipartisan support, the debate continues over how much it will cost, who will foot the bill, and how it should best be administered. In a time of war and tight budgets, will the bill get the attention it deserves?

Substance abuse and addiction are among the most challenging health problems facing our society. Breakthrough discoveries in science continue to refine our understanding of drug abuse and addiction and are yielding new opportunities to translate basic research findings into tangible treatment products. Read about the progress being made by the National Institute on Drug Abuse, the world's largest supporter of research on the health aspects of addiction.

Although there is no pharmacological agent that has been approved by the U.S. Food and Drug Administration for the treatment of autism, new studies are showing promise in not only discovering the cause of autism, but pharmacological treatments as well.

Increasing variations in mechanisms of action of atypical antipsychotics, side-effect profiles, and efficacy among the atypicals enable clinicians to tailor treatments to individual response, side-effect history, and current medical conditions.

With all the various types of medications as well as different formulations that can be used to treat ADHD in adolescents, choosing the right one can be a difficult task. This analysis of the options will help make that choice easier.

In this introduction to our Trauma Special Report, Dr. Novac places the articles in historical perspective and reminds the reader of the importance of understanding trauma within today's global constructs and impending war.

Inpatient care for the wealthy has arrived--fluffy bath robes, in-room Jacuzzis, a concierge at your beck and call. Do the luxuries of these "resorts" negate the care that is being provided, or can patients have the best of both worlds?

In the wake of the deaths of seven astronauts aboard the Space Shuttle Columbia, many critics have called for an end to manned space flights. Psychiatrists, however, point to the intangible benefits--including the societal values and desired psychological traits that are modeled by astronauts.

The field of schizophrenia recently has seen remarkable progress in the understanding and treatment of this disabling condition. Dr. Buckley provides highlights of this special report.

With the seemingly impending war with Iraq, Dr. Stone revisits the Marxist-based film The Battle of Algiers and is surprised to find Islamic fundamentalism prominently featured throughout. Looking back, he finds nothing in the director's or writer's notes, or in critics' writings on the film, to indicate they were aware of its presence-the film was viewed through the context of the time. Are we still making this deadly error in dealing with Muslim nations?

The World Trade Center attack changed the face of the United States and of psychiatry. Men and women of the cloth and of the clinic came together to care for the stricken masses. Yet, members of the clergy do not always refer congregants who exhibit duress to the psychiatrist, nor do psychiatrists refer patients to the clergy. What keeps these two fields apart? What is best for your patient?

While fear stirred the nation during the Washington, D.C.-area sniper episodes, some members of the media were irresponsible in their analysis of the sniper's motives. Has this confirmed the general public's false belief that mental illness is linked to violence?

Groups are important throughout the course of a patient's therapy, especially for patients who have substance use disorders. Group therapy's clinical and cost benefit is evaluated for its efficacy in preventing and treating substance abuse.

Repetitive self-injury can be one of the more difficult conditions to treat. What is the biochemical basis for self-injury and how can psychiatrists treat this condition?

Behavioral and Emotional Problems Among Children of Drug Abusers

Although patients taking opioids for chronic pain may sometimes appear to display addictive behaviors, addiction may not be the case. How can you tell if addiction is the problem or if inadequate pain control is to blame?

When physicians struggle with substance use disorders, physician health programs are an important source of information and support. Certain medical specialties are at higher risk for substance use disorders than are others, and drugs of choice vary by specialty. Physician health and patient safety must be considered, but colleagues can help.

Combination treatment with both a selective serotonin reuptake inhibitor and a form of cognitive-behavioral therapy may be more effective than either treatment alone for this debilitating and often chronic disorder.

Standardized test scores and adaptive functioning will now be used to determine who may be sentenced to death and who may not. Yet, legal and psychiatric experts continue to challenge each other to define mental retardation. Some say that retardation can be feigned and used to weaken the power of the death penalty. Others say the issue will not arise.

Assessing the Violent Patient: An Additional Case of Legal Implications

Treatment with psychopharmaceuticals may prove problematic for pregnant women. The decision to discontinue medications or to adjust dosages to minimize the risk to the fetus has to be addressed. The dynamic balance of treatment options, maternal concerns and practitioner responsibility depends upon staying abreast of the latest research in psychopharmacology and pregnancy.

The threat that a patient may commit an act of violence challenges psychiatrists to wrestle with the legal system as they attempt to successfully build a therapeutic alliance. Patient history, solid medical care, and the duties to warn and to protect must be successfully balanced to navigate the crossroads between psychiatry and the law.