Schizophrenia/Psychosis

In this video, international expert on schizophrenia, Peter F. Buckley, MD, gives an overview of what's new in schizophrenia and discusses the state-of-the-art of diagnosis and management of this complex and challenging disorder.

In light of our problems and uncertainties about the state of current psychiatry, or perhaps because of them, what might describe good psychiatry? Following are some suggestions for what we, as psychiatrists, can do.

An increasing number of patients are being brought to the emergency room because of bath salts and/or herbal incense toxicity.

It is important for the inpatient psychiatrist to understand the perspective of the newly admitted patient. Many patients will find the experience depersonalizing, threatening, and socially alienating and may perceive it as a personal failure.

The Suicide Risk Screening Alert is a clinical tool that assists the psychiatrist and nonpsychiatric physician in identifying patients at risk for suicide during brief medication management appointments.

Ongoing shortages of several psychotropic medications have wreaked havoc among patients and their families, caused frustration and reluctant prescription switches among physicians, and prompted investigations by Congress.

Staying empathic and keeping the conflict within the patient instead of between the patient and health care provider, is a key to successful management.

The trouble with answering this question is that I couldn’t – and still can’t – recall the “best” memory. What much more readily came to mind are some of the worst memories.

The paradigm for modern psychiatry is evidence-based medicine (EBM)-it represents proven treatments for defined diagnoses. But there are major problems with this position, starting with the fact that while they are superior to placebo, evidence-based treatments too often are ineffective.

In a recent interview on 60 Minutes, Harvard psychologist Irving Kirsch, PhD, commented, “the difference between the effect of a placebo and the effect of an antidepressant is minimal for most people.”

Much could be gained if an agreed minimum set of appropriate and important outcomes was measured and reported in all clinical trials in a particular area.

Insight can be assessed in the course of a typical evaluation or follow-up interview with augmentation by questions borrowed from any of the validated insight rating scales.

When thinking about recent advances in psychopharmacology, we often point to new molecules with similar mechanisms of action but with better safety and tolerability profiles, or to molecules with novel mechanisms that effect positive change greater than that with existing treatments.

Adequate treatment of the underlying psychiatric illness consistently appears to be the most effective use of medication in suicidal patients.

Several studies have been undertaken to test the efficacy of drugs in the management of aggression and hostility in patients with schizophrenia and other mood disorders.

He wasn’t the first person I met days before I was to start my psychiatric residency, but as I walked about in my new city, he caught my attention much more than most. As psychiatrists, we typically assume that we will hear the inside stories, even if in bits and pieces, that will help us better understand and help patients. But perhaps we are too expectant . . .

With several good presentations going on today at EPA 2012, the hardest part was deciding which to attend. The sessions started at 8 this morning, and I decided to go to the Treating Schizophrenia Beyond Antipsychotic Drugs: Cognitive and Metacognitive Interventions.

Does an early diagnosis of schizophrenia really make a clinical difference?

Three twin studies published between 1977 and 1995, which provided the main body of knowledge on heritability of autism, showed a concordance rate of 72% for a total of 36 monozygotic pairs and a concordance rate of 0% for 30 dizygotic pairs.

In this article the topic addressed are the primary reasons for the American public’s disenchantment with psychiatry; how the profession ought to address these issues; and how we need to replace the DSM’s categorical system with one that is clinically useful for both clinicians and patients.

The plain fact is that nothing that has been claimed in the name of defending our country can justify cruel, inhuman, and degrading treatment of another man or woman. Torture, in any form-light or heavy-is not a tool of interrogation or useful for gathering good intelligence.

Studies of mammalian species suggest that they possess awareness of self and even more subtle “human” qualities associated with empathy and social joy.

Charles Dickens might well say of American psychiatry, “These are the best of times and the worst of times.”

Here's a sampling of Psychoeducational Resources with live links including those available from the NIMH (NIMH Schizophrenia_ and Learning About Healthy Living.

Schizophrenia is often characterized by lack of insight, treatment nonadherence, and poor prognosis. However, research suggests that patients with schizophrenia benefit immensely from learning about their illness.

Dr Angell and others may be right to claim that we should be concerned about the current practice of psychiatry. But the simple fact that mental illnesses seem to be common is not one of them.

Do you know someone that has fought the brave fight against serious mental illness? They deserve recognition and applause. Do nominate them or let them know of the Reintegration Awards.

While research suggests that cannabis use can induce an acute psychotic state, there is controversy about whether it may precipitate psychotic disorders, such as schizophrenia. These authors offer an update on this important issue and provide clinically useful recommendations.

Through patient self-management, mental health clinicians can transfer the focus from managing symptoms to allowing patients to live well in the context of their mental illness and medical comorbidities.

Critics of DSM-5 argue that the expansion of diagnostic criteria may increase the number of “mentally ill” individuals and/or pathologize “normal” behavior, and lead to the possibility that thousands-if not millions-of new patients will be exposed to medications which may cause more harm than good.