Psychiatry Archives - Page 6 of 7 - searchfortruth.info

Amnesia for Homicide (“Pedicide”)Its Treatment With Hypnosis

November 24, 2018October 9, 2017 by admin

Abstract

Guttmacher and Weihofen1 have pointed out that "the recollection of crime is often incomplete with a spotty amnesia which may clear up only partially under sodium pentothal or one of the other abreactive drugs." The author will present the cases of two women who murdered their children and subsequently suffered from a complete amnesia for the details of these crimes. In each case the woman had some vague recollection of having killed her child, but had forgotten all of the specific details of the homicide and the surrounding events. The cases are presented for the purpose of elucidating three factors.

1. The phenomenology and some of the causative factors of such crimes.

2. The phenomenology and dynamics of the concurrent amnesia.

3. The usefulness of hypnosis in elucidating factors 1 and 2 by a recovery of the forgotten events.

Clinical Manual of Pain Management in Psychiatry

November 24, 2018October 10, 2017 by admin

While recognizing the multidisciplinary nature of pain management, the Clinical Manual of Pain Management in Psychiatry focuses on the role of mental health practitioners in evaluation and assessment, pharmacological management, psychotherapeutic interventions, and comprehensive treatment planning. It balances theoretical foundations of pain pathophysiology with applied clinical information, providing guidelines to psychiatric differential diagnosis of pain states and psychiatric comorbidities associated with pain and integrating diagnostic and treatment approaches. Because proper treatment requires understanding the whole person, the book views the patient from biological, psychological, and social perspectives. It stresses the importance of examining psychological variables that can limit outcomes and even preclude aggressive interventional approaches. The manual also includes considerations pertinent to the elderly, children, and cultural groups.

This manual expands on the author's previous Concise Guide to Pain Management for Psychiatrists to reflect significant advances in the field of pain medicine. It updates trends in treatment approaches along...

Hypothyroidism: An Important Diagnostic Consideration for the Psychiatrist

November 24, 2018October 10, 2017 by admin

Hypothyroidism is a clinical state of thyroid hormone deficiency that may have a primary or secondary (central) cause. Primary hypothyroidism, which is more common than secondary hypothyroidism, is defined as failure of the thyroid gland to respond appropriately to thyroid-stimulating hormone (TSH) produced in the anterior pituitary gland. Primary hypothyroidism can be caused by autoimmune disease (Hashimoto disease), iodine deficiency, or infiltrative diseases, or it can be caused iatrogenically by surgery or irradiation of the gland. Subclinical hypothyroidism refers to mildly increased TSH levels in the setting of normal thyroxine (T4) and triiodothyronine (T3) levels. Secondary hypothyroidism is defined as insufficient thyroid gland stimulation by the hypothalamus or pituitary gland.

What new information does this article provide?

This article provides a simple and concise review of the varied physical and neuropsychiatric presentations of hypothyroidism and important diagnostic and treatment information.

What are the implications for psychiatric practice?

Hypothyroidism presents with a myriad of neuropsychiatric...

Extended Release Drug Delivery Strategies in Psychiatry

November 24, 2018October 10, 2017 by admin

Abstract

Objective: An overview of the emerging field of long-term delivery strategies for improved convenience and adherence with psychiatric medications is provided. This review is motivated by the hypothesis that adherence to treatment is an important determinant of clinical outcomes in a wide range of settings and is particularly important in psychiatry practice where patients require treatment for months or years and premature discontinuation can have serious consequences for patient health and quality of life.

Design: The author reviews the relevant literature and highlights several approaches to providing improved access to continuous medication through new and innovative delivery strategies ranging from days to annual intervals.

Benefits and Disadvantages: Several solutions to the problem of discontinuous access to pharmacotherapy are being developed in the form of new, long-acting drug-delivery systems, which gradually release medication over a period of several days or weeks with a single application. Long-acting formulations of psychiatric medications offer...

Fluoxetine Delayed Release Capsules

November 24, 2018October 10, 2017 by admin

WARNING: SUICIDAL THOUGHTS AND BEHAVIOR

Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk with antidepressant use in patients aged 65 and older [see Warnings and Precautions (5.1)]. psy

In patients of all ages who are started on antidepressant therapy, monitor closely for worsening and for emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber [see Warnings and Precautions (5.1).

Fluoxetine is not approved for use in children less than 7 years of age [see Warnings and Precautions (5.1) and Use in Specific Populations (8.4)]. Indications and Usage for Fluoxetine Delayed Release Capsules

Fluoxetine delayed-release capsules are indicated for the treatment of: ...

Noise, Noise Sensitivity And Psychiatric Disorder: Epidemiological And Psychophysiological Studies.

November 24, 2018October 11, 2017 by admin

Abstract

Noise, a prototypical environmental stressor, has clear health effects in causing hearing loss but other health effects are less evident. Noise exposure may lead to minor emotional symptoms but the evidence of elevated levels of aircraft noise leading to psychiatric hospital admissions and psychiatric disorder in the community is contradictory. Despite this there are well documented associations between noise exposure and changes in performance, sleep disturbance and emotional reactions such as annoyance. Moreover, annoyance is associated with both environmental noise level and psychological and physical symptoms, psychiatric disorder and use of health services. It seems likely that existing psychiatric disorder contributes to high levels of annoyance. However, there is also the possibility that tendency to annoyance may be a risk factor for psychiatric morbidity. Although noise level explains a significant proportion of the variance in annoyance, the other major factor, confirmed in many studies,..

Learned Helplessness: Theory and Evidence

November 23, 2018October 11, 2017 by admin

Abstract

Reviews the literature which examined the effects of exposing organisms to aversive events which they cannot control. Motivational, cognitive, and emotional effects of uncontrollability are examined. It is hypothesized that when events are uncontrollable the organism learns that its behavior and outcomes are independent, and this learning produces the motivational, cognitive, and emotional effects of uncontrollability. Research hich supports this learned helplessness hypothesis is described along with alternative hypotheses which have been offered as explanations of the learned helplessness effect. The application of this hypothesis to rats and man is examined...

Substance-Induced Disorders

November 23, 2018October 11, 2017 by admin

The toxic effects of substances can mimic mental illness in ways that can be difficult to distinguish from mental illness. This chapter focuses on symptoms of mental illness that are the result of substance abuse—a condition referred to as “substance-induced mental disorders.”

Overview Description Alcohol Caffeine Cocaine and Amphetamines Hallucinogens Nicotine Opioids Sedatives Diagnostic Considerations Case Studies: Identifying Disorders

Description As defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (American Psychiatric Association [APA] 2000) (DSM-IV-TR), substance-induced disorders include:

Substance-induced delirium Substance-induced persisting dementia Substance-induced persisting amnestic disorder Substance-induced psychotic disorder Substance-induced mood disorder Substance-induced anxiety disorder Hallucinogen persisting perceptual disorder Substance-induced sexual dysfunction Substance-induced sleep disorder

Substance-induced disorders are distinct from independent cooccurring mental disorders in that all or most of the psychiatric symptoms are the direct result of substance use. This is not to state that substance-induced disorders preclude co-occurring mental disorders, only that...

Deception And Self-deception In Shamanism And Psychiatry.

November 20, 2018October 14, 2017 by admin

Abstract

The author argues that both shaman and psychiatrist are obliged to use a degree of self-deception in assuming their roles. The shaman must rationalize his use of trickery to impress his patients, and the psychiatrist deceives himself that his psychotherapeutic techniques have specific healing properties in the face of evidence which suggests that he often merely mobilizes the general effects of placebo and suggestion. Shaman and psychiatrist appear to use the same mental mechanisms in deceiving themselves. Inadequate method and theory may be supported by reference to personal experience and unrelated data or defended by circular reasoning or comparison with an even more inadequate system. The practitioner may also allow his perception of his abilities to be moulded by social consensus...

Psychostimulants in Psychiatry.

November 20, 2018October 14, 2017 by admin

Abstract

The use of the psychostimulants in psychiatry is reviewed. A brief historical perspective on dextroamphetamine is presented, and a brief review of the psychopharmacology of dextroamphetamine, methylphenidate and magnesium pemoline is given. The literature on the use of stimulants in the treatment of resistant depression, apathetic geriatric patients and patients medically ill with a secondary depression is summarized and two case histories given to illustrate the clinical usefulness of the stimulants. The literature on the use of stimulants as an adjunct to antidepressant therapy and as a diagnostic test is also discussed. Finally the use of stimulants in obsessional illness and adult attention deficit disorder is summarized. The writer concludes by commenting that the stimulants have a very useful role in the treatment of certain categories of depression...

Law & Psychiatry: Mental Illness, Police Interrogations, and the Potential for False Confession

November 20, 2018October 14, 2017 by admin

Recently, an alarmingly high incidence of wrongful convictions has been documented in the United States, in large part because of "Innocence Projects" that use DNA analyses from crime scenes to exonerate innocent persons. The best-known Innocence Project, administered through the Benjamin N. Cardozo School of Law in New York, has helped to free 138 people who had been wrongfully incarcerated. Approximately 25 percent of these cases involved false confessions arising from inappropriate police interrogations. Among these false confession cases, persons with mental impairment appear to be disproportionately represented. The Innocence Project's Web site notes, "Truly startling is the number of false confession cases involving the mentally impaired and the mentally ill. Police interrogation in the [false confession] cases reveals a lack of training and a disregard for mental disabilities" (1).

An example of where this situation can lead is the case of Eddie Joe Lloyd, who spent 17 years

The Noncompliant Patient in Psychiatry: The Case For and Against Covert/Surreptitious Medication

November 20, 2018October 14, 2017 by admin

Abstract

Nonadherence to treatment continues to be one of psychiatry’s greatest challenges. To improve adherence and thus improve the care of patients, clinicians and patients’ family members sometimes resort to hiding medication in food or drink, a practice referred to as covert/ surreptitious medication. The practice of covert drug administration in food and beverages is well known in the treatment of psychiatrically ill world-wide but no prevalence rates exist. Covert medication may seem like a minor matter, but it touches on legal and ethical issues of a patient’s competence, autonomy, and insight. Medicating patients without their knowledge is not justifiable solely as a shortcut for institutions or families wishing to calm a troublesome patient and thus alleviate some of the burdens of care giving. The paramount principle is ensuring the well-being of a patient who lacks the competence to give informed consent. Ethically, covert/surreptitious...

The Role of Stimulants in Late-Life Depression

November 20, 2018October 14, 2017 by admin

In this issue, Lavretsky and colleagues report the results of a controlled study to determine whether the addition of methylphenidate to citalopram would accelerate and enhance antidepressant response in older adults (1). This was a 16-week, double-blind, three-arm, parallel-design study comparing the combination of methylphenidate and citalopram and either drug plus placebo. The study builds on previous work by the authors. The study participants had a mean age of 69 years, and all had a diagnosis of major depressive disorder. The authors found that the combination treatment accelerated response and increased the remission rate, and the differences were statistically significant and clinically meaningful. The authors also examined whether adjunctive methylphenidate improved cognition. Although cognition improved with treatment, there were no significant differences between treatments. This is a high-quality study, both in design and in the careful reporting of results.

Figure 1, from the online data supplement of the Lavretsky et al...

Industry Sponsorship And Financial Conflict Of Interest In The Reporting Of Clinical Trials In Psychiatry.

November 20, 2018October 14, 2017 by admin

Abstract

OBJECTIVE: Financial conflict of interest has been reported to be prevalent in clinical trials in general medicine and associated with a greater likelihood of reporting results favorable to the intervention being studied. The extent and implications of industry sponsorship and financial conflict of interest in psychiatric clinical trials have not been investigated, to the authors' knowledge.

METHOD: The authors examined funding source and author financial conflict of interest in all clinical trials published in the American Journal of Psychiatry, the Archives of General Psychiatry, the Journal of Clinical Psychopharmacology, and the Journal of Clinical Psychiatry between 2001 and 2003.

RESULTS: Among 397 clinical trials identified, 239 (60%) reported receiving funding from a pharmaceutical company or other interested party, and 187 studies (47%) included at least one author with a reported financial conflict of interest. Among the 162 randomized, double-blind, placebo-controlled studies examined, those that reported conflict of interest were 4.9...

Fatal Toxicity Of Drugs Used In Psychiatry.

November 20, 2018October 14, 2017 by admin

Abstract

Certified deaths from fatal poisoning (accidents, suicides and open verdicts) in England and Wales have declined steadily (from 3952 in 1979 to 2565 in 2004). There was also a small annual reduction in suicides in males and in females over this period. In 2004, self-poisoning accounted for 25% of suicides and open verdicts in males (n = 862) and 45% in females (n = 540). Poisoning death rates per million prescriptions were about 10 times higher for tricyclic antidepressants (TCAs) than for selective serotonin reuptake inhibitors (SSRIs), England and Wales, 1993-2004. However, despite the increased prescription of SSRIs and related compounds in recent years, there has been only a slight decrease (some 10%) in the annual number of antidepressant-related poisoning deaths, in line with the reduction in suicides (all methods) over this period. Citalopram appears to have higher overdose toxicity than other SSRIs. Of newer non-SSRI antidepressants, the overdose...

The Effectiveness of Psychotherapy

November 17, 2018July 13, 2017 by admin

Abstract.

Consumer Reports (1995, November) published an article which concluded that patients benefited very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse. The methodological virtues and drawbacks of this large-scale survey are examined and contrasted with the more traditional efficacy study, in which patients are randomized into a manualized, fixed duration treatment or into control groups. I conclude that the Consumer Reports survey complements the efficacy method, and that the best features...