Physician burnout and mental health

What makes a psychiatrist?

Why the diagnosis of bipolar disorder isn’t clear

August 29, 2012Aug 29, 20124

I have a confession to make. I don’t know what “bipolar disorder” is. And as a psychiatrist, I’ll admit that’s sort of embarrassing. Okay, maybe I’m exaggerating when I say that I don’t know what bipolar disorder is. Actually, if…

I have a confession to make. I don’t know what “bipolar disorder” is. And as a psychiatrist, I’ll admit that’s sort of embarrassing.

Okay, maybe I’m exaggerating when I say that I don’t know what bipolar disorder is. Actually, if you asked me to define it, I’d give you an answer that would probably sound pretty accurate. I’ve read the DSM-IV, had years of training, took my Boards, treated people in …

Involuntary commitment for James Holmes: Is his psychiatrist to blame?

MedPage Today

August 2, 2012Aug 2, 20125

The majority of killers involved in recent mass shootings had encounters with the mental healthcare system before they committed their acts of violence, with some even being legally compelled to seek help. Few seemed surprised when it came out over…

Few seemed surprised when it came out over the weekend that James Holmes, 24, who allegedly killed 12 and wounded 58 others at a movie theater shooting in Aurora, …

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Eliminate the guilt in parenting

Claudia M. Gold, MD

July 24, 2012Jul 24, 20122

In my behavioral pediatrics practice, it is not uncommon for parents to go to great lengths to put up a good front. They feel terrible shame about moments of out-of-control behavior, and also fear that I will blame them for their child’s troubles. They focus primarily on “what to do” about their child’s difficult behavior. However with time, and the realization that I am interested in understanding, not shaming or …

Eliminate the guilt in parenting

What could bring psychiatry to its knees, or save it

July 23, 2012Jul 23, 201210

The practice of medicine has changed enormously in just the last few years. While the upcoming implementation of the Affordable Care Act promises even further—and more dramatic—change, one topic which has received little popular attention is the question of exactly who provides medical services. Throughout medicine, physicians (i.e., those with MD or DO degrees) are being replaced by others, whenever possible, in an attempt to cut costs and improve access …

DSM-5 will capture the dynamic nature of mental illness

David Kupfer, MD

July 20, 2012Jul 20, 2012

Much of the debate over the future edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has centered on what disorders will be added, modified or dropped. But lost in the discussion is a change that will align…

Much of the debate over the future edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has centered on what disorders will be added, modified or dropped. But lost in the discussion is a change that will align disorders along a developmental continuum—one that looks at them across the lifespan. This shift will provide clinicians with a critical perspective that until now has been missing.

Historically, disorders were classified …

Do people need to suffer the consequences of their bad behavior?

Greg Smith, MD

July 19, 2012Jul 19, 201211

You know the headlines. You read them and hear them and see them every day. Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and…

You know the headlines. You read them and hear them and see them every day.

Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and ammunition ahead of time, stalked the victims, checked the schedules and shown up at the right time to do maximum damage.

A family including mother and young children in a van are …

Drugs and prescribing

What are bath salts and why are they dangerous?

Roy Michael Stefanik, DO

July 5, 2012Jul 5, 20123

Bath salts are a relatively new group of designer drugs sold as tablets, capsules, or powder and purchased in places such as tobacco and convenience stores, gas stations, head shops, and the Internet. They are stimulants that mimic cocaine, lysergic…

They are stimulants that mimic cocaine, lysergic acid diethylamide (LSD), methamphetamine, or methylenedioxymethamphetamine (ecstasy). According to a recent article in the Journal of Psychosocial Nursing, the most common bath salts are MDPV, mephedrone, and methylone. These drugs cause …

Drugs and prescribing

Applying ADHD lessons to medical marijuana

July 4, 2012Jul 4, 20124

An article in the New York Times recently described the increasing use of stimulant medications such as Adderall and Ritalin among high-school students. Titled “The Risky Rise of the Good-Grade Pill,” the article discussed how 15 to 40 percent of…

An article in the New York Times recently described the increasing use of stimulant medications such as Adderall and Ritalin among high-school students. Titled “The Risky Rise of the Good-Grade Pill,” the article discussed how 15 to 40 percent of students, competing for straight-As and spots in elite colleges, use stimulants for an extra “edge,” regardless of whether they actually have ADHD. I’ve written about ADHD. It’s a real …

Ask your doctor smart health questions

Dinah Miller, MD

June 26, 2012Jun 26, 20125

Going to the doctor can be confusing. Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors. While I think it's wonderful that patients trust their doctors, there are times when patients want more…

Going to the doctor can be confusing. Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors. While I think it’s wonderful that patients trust their doctors, there are times when patients want more input into their health care, and if this is the case, then let me make some suggestions as to what might be important questions to ask. There is nothing specific …

Ask your doctor smart health questions

What does patient centered care say about psychiatry as a science?

June 20, 2012Jun 20, 20123

When asked what makes for good patient care in medicine, a typical answer is that it should be “patient-centered.” Sure, “evidence-based medicine” and expert clinical guidelines are helpful, but they only serve as the scientific foundation upon which we base our individualized treatment decisions. What’s more important is how a disorder manifests in the patient and the treatments he or she is most likely to respond to (based on genetics, …

Medical education

Should medical students consider a combined psychiatry residency?

Julia Frank, MD

June 19, 2012Jun 19, 2012

“What about combined psychiatry-family medicine-neurology-internal medicine programs? Should I try to do a triple board program in psychiatry-child psychiatry and pediatrics?” Every April, I field such questions from a slew of rising fourth year students who have become, to their…

“What about combined psychiatry-family medicine-neurology-internal medicine programs? Should I try to do a triple board program in psychiatry-child psychiatry and pediatrics?”

Every April, I field such questions from a slew of rising fourth year students who have become, to their surprise (and sometimes dismay), passionately interested in psychiatry. Psychiatry is a shortage specialty and psychiatric issues rank high among the challenges facing medical care systems here and around the world. For …

Patient voices

Reflecting on the first AA meeting

Nonmaleficence

June 5, 2012Jun 5, 201212

I recently attended my first AA meeting. It surpassed many of my expectations; however it ruined others and left me slightly dumbfounded. My imagination, with the help of television and movies, painted a picture in my mind of what an…

I recently attended my first AA meeting. It surpassed many of my expectations; however it ruined others and left me slightly dumbfounded.

My imagination, with the help of television and movies, painted a picture in my mind of what an AA meeting would be like. It portrayed a room filled with people that obviously looked like addicts; unkempt appearances, borderline offensive hygiene, and at least one person emitting a radiance of …

Reflecting on the first AA meeting

Solving the different behaviors that lead to obesity

Roxanne B. Sukol, MD

June 4, 2012Jun 4, 20127

All kinds of behaviors can have an effect on your weight, and the solution to each is different. Maybe portion size is your biggest issue. Maybe it’s hard to get moving, even though you know you need to get some…

All kinds of behaviors can have an effect on your weight, and the solution to each is different.

Maybe portion size is your biggest issue. Maybe it’s hard to get moving, even though you know you need to get some exercise. Maybe you have a sweet tooth that you can’t shake. Maybe you’re completely stressed out, and you never get a decent night’s sleep. Maybe you are a nighttime snacker. Or …

When the homeless disappear

Maria Yang, MD

May 29, 2012May 29, 20127

Two weeks had passed before I learned what happened. I hadn’t seen him in several months. At our last meeting, the trees were full of red and orange leaves. He, as usual, was not interested in talking to me. He…

Two weeks had passed before I learned what happened.

I hadn’t seen him in several months. At our last meeting, the trees were full of red and orange leaves. He, as usual, was not interested in talking to me. He was sitting in front of a closed shop.

“Hi. How are you?”

“Fine.”

People in the neighborhood took care of him. Surrounding him were several plastic bags holding neatly stacked styrofoam containers filled with soup. …

When the homeless disappear

Compassion fatigue is an early warning sign of physician burnout

Dike Drummond, MD

May 28, 2012May 28, 20129

For anyone in the helping professions, compassion fatigue is a common occurrence and a clear signal to take better care of your own needs. Compassion fatigue is when you find yourself challenged to care about your patients in the way…

For anyone in the helping professions, compassion fatigue is a common occurrence and a clear signal to take better care of your own needs.

Compassion fatigue is when you find yourself challenged to care about your patients in the way you know is proper and expected in your position. One of the key components of quality healthcare is the ability for you to connect with your patients and for them to …

Medical education

How we treat sexual assault matters more than we will ever know

Natalie

May 28, 2012May 28, 20124

My psych final was this morning, which I am 90% confident I did well enough on to pass the class (which is all I need to be satisfied). Considering I counted watching “Girl, Interrupted” as studying, I say that’s not…

I felt like there were many necessary topics left out of our behavioral medicine and psychiatry course. One of the many: sexual assault.

For the past eight years I have …

Medical education

A medical student’s first patient interview

Charles Casassa

May 25, 2012May 25, 20126

“Um—Hi there, I’m a, uh, you know. Medical student. First year. For, you know, the Patient-Doctor—err, Patient-Physician course—” The nurse smiled and turned to a woman of shorter stature with bony, scrunched- up shoulders. “Mary, do you want this first…

“Um—Hi there, I’m a, uh, you know. Medical student. First year. For, you know, the Patient-Doctor—err, Patient-Physician course—”

The nurse smiled and turned to a woman of shorter stature with bony, scrunched- up shoulders. “Mary, do you want this first year to interview you?”

Mary was about to set foot in the lounge when she heard this. She let out a sigh and faced me. Her eyes looked worn; I could tell …