From the Pages of Psychiatric Times: August 2022

In the August issue of Psychiatric Times^TM, we worked with experts from multiple psychiatric areas to bring you thoughtful articles about a wide variety of psychiatric issues, from assessing mixed affective states to understanding and addressing substance use and misuse in clinicians. Here are some highlights from the issue.

Exploring Diagnostic Strategies in the Assessment of Mixed Affective States

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Depression has been well known to the medical community for multiple millennia. Through the ages, the understanding of depression and other affective disorders has undergone multiple revisions based on an evolving foundation of knowledge from contributing scientists and physicians. In 400 BCE, Hippocrates first used the terms mania and melancholia as a means of describing mental illness. Later, in the year 30 AD, Celsus, who was a physician in Rome, noticed that there was a relationship between depression and black bile, thus describing the term melancholia in his work De re medicina. As the understanding of mood disorders broadened over the centuries, clinicians began to notice the tendency for patients to fluctuate between mood states. Continue Reading

School Shooters and Psychopathy: A Rush to Judgment?

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It took only 48 hours for the pop psychology “diagnosis” of the Uvalde, Texas, shooter to hit the internet. One headline screamed, “A teenage psychopath is still a psychopath….” One prominent politician declared the shooter to be a “psychopath,” and another upped the ante, describing him as a “heartless psychopath.”

Several anonymous online comments ran along the lines of, “Who else but a psychopath could murder a room full of innocent schoolchildren?” That is a perfectly understandable question among the general public, but it amounts to little more than a circular argument and plays fast and loose with the concept of “psychopath.” Continue Reading

What Are Clinicians Missing About Catatonia?

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Catatonia is a psychomotor syndrome that features too little (hypokinetic), too much (hyperkinetic), or abnormal (parakinetic) movement and presents in association with primary mental illness or other medical conditions. An individual with catatonia may develop life-threatening autonomic abnormalities—a condition called malignant catatonia. Persistent or severe catatonia can also lead to a wide variety of medical complications. Prompt identification and management are imperative.

An estimated 5% to 10% of acute psychiatric inpatients have catatonia, with a growing body of literature describing catatonia in acute medical settings as well. Despite the prevalence of catatonia and its clinical impact, catatonia remains widely underdiagnosed. In fact, 2 separate studies found that roughly only 1 in 10 cases of catatonia was recognized by psychiatric inpatient treatment teams. Although several factors likely play a role, we believe that a widespread lack of understanding catatonia’s clinical diversity may be a large reason catatonia so often goes undiagnosed. Continue Reading

Understanding and Addressing Physician Substance Use and Misuse

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Doctors and health care professionals are having a difficult time right now. Even before the COVID-19 pandemic, our rates of burnout were steadily rising to the point that half of physicians have at least 1 symptom of burnout. We have one of the highest suicide rates of any profession, with female physicians being particularly vulnerable. A quarter to one-third of our students and trainees are reported to be suffering from clinical depression. The pandemic has exacerbated all the stressors that are fueling these tragic statistics.

A related issue that is not discussed nearly as thoroughly or as openly as it should be is that of physicians and addiction. Physicians become addicted to drugs or alcohol at least as commonly as the general population does. It is thought that 10% to 14% of physicians suffer from addiction to drugs or alcohol during their careers. Continue Reading

See the full August issue of Psychiatric Times^TM here. And be sure to stay up-to-date by subscribing to the Psychiatric Times^TM E-newsletter.

Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at PTeditor@mmhgroup.com.