Medical Psychiatry Research Articles

Medical Student Psychiatry Examination Performance at VA and Non-VA Clerkship Sites

The authors examined the effects of medical student assignment to U.S. Department of Veterans Affairs (VA) Medical Center inpatient and outpatient psychiatry clerkship sites versus other university and community sites on the performance outcome measure of National Board of Medical Examiners (NBME) subject examination scores. NBME psychiatry scores were compared for stratified random samples of 70 students each for inpatient and outpatient VA and non-VA sites, controlling for baseline clinical knowledge as reflected by second year Human Behavior course scores. No significant differences were demonstrated in NBME scores between VA and non-VA sites for either inpatient or outpatient programs. Assessed students rotating through several VA clinical sites were as well prepared for NBME subject examinations as those assigned to other sites. Additional measures of educational outcome for VA sites are recommended to assess and enhance clinical education provided by the VA and to strengthen collaboration with university-based medical student teaching programs.

Die Bedeutung der Lehre im Spannungsfeld zwischen «Evidence-based Medicine» und «Experience-based Medicine»

As a medical discipline Child and Adolescent Psychiatry and Psychotherapy has gained increasing importance within society since given the epidemiological importance of behavioural problems in childhood and adolescence, it has verifiably improved the developmental chances of children at high risk. Child and Adolescent Psychiatry and Psychotherapy therefore should be systematically integrated into the German Medical Curriculum. The bio-psycho-social model provides us with a comprehensive paradigm of psychiatric disorders and has to face the problem of hermeneutics. An equilibrium between Evidence-based Medicine and the individual clinical experience with patients (Experience-based Medicine) must be established within medical teaching, rather than playing one against the other. Ethical dilemmas of medical therapy have to be taken into account.

Best evidence medical education and psychiatry in Ireland: a three step framework for change.

Best evidence medical education and psychiatry in Ireland: a three step framework for change.

Medical Psychiatry

Medical Psychiatry

A 2-year Progress Report of the AACAP-Harvard Macy Teaching Scholars Program

The American Academy of Child and Adolescent Psychiatry (AACAP) has partnered with the Harvard Macy Program for Healthcare Educators so that selected child and adolescent psychiatry academic faculty might enhance their teaching expertise in order to possibly enhance recruitment of medical students into child and adolescent psychiatry. Thirteen child psychiatry faculty have graduated from the AACAP-Harvard Macy Teaching Scholars Program (HMTSP). There are 10 additional child and adolescent psychiatry faculty members in the process of completing the program. A survey was created to broadly assess the effect of the AACAP-HMTSP training on the first 13 graduates of the program as a pilot to guide future study of the program. Three teaching scholars who are the first authors of this article (JH, DS, MH) conducted this survey and the data interpretation for this study. Thirteen of the scholars submitted responses to the survey. All participants indicated a high degree of satisfaction with the HMTSP and with the overall usefulness of the concepts learned. All but one of the scholars reported that the program enhanced their teaching effectiveness. The scholars reported increased teaching of medical students (9 of 13) and psychiatry residents (6 of 13) after the HMTSP. The AACAP-Harvard Macy Teaching Scholars reported high levels of satisfaction with the overall program. Whether the reported increase in medical student and psychiatry resident mentoring and teaching will eventually lead to increased medical student recruitment into child and adolescent psychiatry remains to be determined.

Development and Implementation of an Objective Structured Clinical Examination to Provide Formative Feedback on Communication and Interpersonal Skills in Geriatric Training

Teaching and assessment of communication and interpersonal skills, one of the American Council for Graduate Medical Education-designated core competencies, is an important but difficult task in the training of physicians. Assessment of trainees offers an opportunity to provide explicit feedback on their skills and encourages learning. This article describes a pilot study in which clinician-educators affiliated with the geriatrics training programs at Beth Israel Deaconess Medical Center and Boston University Medical Center designed and piloted a novel Objective Structured Clinical Examination (OSCE) to assess the communication and interpersonal skills of medical, dental, and geriatric psychiatry fellows. The OSCE consisted of three stations where geriatricians and standardized patients evaluated candidates using specifically designed checklists and an abbreviated version of the Master Interview Rating Scale. Communication skills were assessed through performance of specific "real life" clinical tasks, such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills were assessed through the effect of the communication between doctor and standardized patient on fostering trust, relieving anxiety, and establishing a therapeutic relationship. This pilot study demonstrated that the OSCE format of assessment provides a valid means of evaluating the communication and interpersonal skills of interdisciplinary geriatric trainees and provides a valuable forum for formative assessment and feedback. Given that geriatricians and non geriatricians involved in elder care both need communication and interpersonal skills, this novel OSCE can be used for assessment of these skills in trainees in diverse healthcare subspecialties.

Academic Training in a Child and Adolescent Psychiatry Fellowship: A Curriculum Based on Leadership Experience

The authors describe how one child and adolescent psychiatry fellowship program responded to emerging trends in clinical practice which increasingly demand that child and adolescent psychiatrists lead their colleagues through instruction and supervision. Data from surveys of recent graduates of child and adolescent training programs were reviewed and the trends were identified. The authors describe the Academic Chief Fellow rotation, which was designed for the fellows to enhance their academic skills by teaching, guiding, and supervising their junior colleagues. The authors describe the implementation of the new rotation and discuss the fellows' response. They also detail the responses of the medical students and residents who rotated on the child and adolescent psychiatry service under the Academic Chief Fellow. Greater experience in teaching and supervising others can be meaningfully integrated into existing child and adolescent psychiatry fellowship curricula. Other outcomes may include greater medical student and general psychiatry resident satisfaction with their child and adolescent psychiatry rotation and greater interest among medical students in child and adolescent psychiatry as a career.

The Child and Adolescent Mental Health Studies (CAMS) Minor at New York University

The authors describe the Child and Adolescent Mental Health Studies (CAMS) undergraduate college minor at New York University. The authors detail the development, structure, and operation of the CAMS minor. They describe the importance of identifying program goals, building coalitions, creating an advisory board, selecting teaching materials and instructors, and establishing a viable financial model. The authors present student evaluations from the first course, which demonstrate great satisfaction with the program. The successful development of the CAMS minor demonstrates that Schools of Medicine (more specifically, the departments of Psychiatry and Child and Adolescent Psychiatry) can have a positive impact on undergraduate student education, which may later translate into an increased number of students who consider entering medical school and child psychiatry.

ECT Treatment for Two Cases of Dementia-Related Pathological Yelling

ECT Treatment for Two Cases of Dementia-Related Pathological Yelling

ECT Treatment for Two Cases of Dementia-Related Pathological Yelling

ECT Treatment for Two Cases of Dementia-Related Pathological Yelling

Risperidone Treatment of Complex Hallucinations in a Patient With Posterior Cortical Atrophy

Back to table of contents Previous article Next article LETTERFull AccessRisperidone Treatment of Complex Hallucinations in a Patient With Posterior Cortical AtrophyJohn J. Campbell M.D.,Gilda Ngo M.D.,John J. Campbell M.D.Search for more papers by this author,Gilda Ngo M.D.Search for more papers by this author,Published Online:1 Jul 2008AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleTo the Editor: Posterior cortical atrophy is a clinical syndrome in which Alzheimer’s disease seems to be the major pathologic cause. 1 – 4 This progressive dementia initially presents with visual disturbances, including some or all features of Balint’s syndrome and Gerstmann’s syndrome, with a later onset of cognitive decline associated with typical Alzheimer’s disease. 1 – 4 Postmortem studies show predominant occipitoparietal atrophy generally associated with neuritic plaques and neurofibrillary tangles. 3 Visual hallucinations occur in up to 25% of patients who are diagnosed with posterior cortical atrophy. 1 , 4 We report a case of a patient with posterior cortical atrophy who was experiencing intolerable complex hallucinations that were successfully treated with risperidone after an unsuccessful trial of quetiapine. Case ReportA 66-year-old married, Caucasian woman with a 10-year history of cognitive decline, characterized by early onset of visual impairment not associated with anterior visual pathology, was brought to the psychiatric emergency department by her daughter for severe mental distress caused by visual and auditory hallucinations. The hallucinations consisted of a young, vulgar girl who reportedly stole the patient’s clothing, demanded to eat the patient’s food, falsely informed the patient that her husband was physically ill, and threatened to kill the family pet. The patient was often awake at night agitated and responding to the hallucinations.The hallucinations began about 8 weeks earlier. Two weeks prior to the emergency department visit, the patient was prescribed quetiapine, 50 mg b.i.d., by her primary care physician. Her medications also included memantine, 10 mg b.i.d., donepezil, 10 mg daily, and venlafaxine XR, 150 mg daily.Upon examination, the patient had Balint’s syndrome, Gerstmann’s syndrome, ideational and ideomotor apraxia, prosopagnosia, fluent aphasia with anomia, and demonstrated paraphasias and neologisms. She had difficulty maintaining and shifting set. A physical exam was unremarkable, but notable for the absence of parkinsonian signs such as cogwheel rigidity, stooped posture, shuffling gait, bradykinesia, and resting tremor. A brain CT showed diffuse cortical atrophy with a pronounced parieto-occipital predomination. The patient was diagnosed with probable Alzheimer’s disease with posterior cortical atrophy syndrome.The patient was admitted to the inpatient medical psychiatry unit and treated with risperidone, 1 mg h.s. Quetiapine was discontinued and her preadmission medications were continued. Initially, the patient was often found verbally responding to the hallucinations, was tearful, and was not able to be redirected. Over the course of 10 hospital days, the hallucinations significantly decreased in frequency and severity. She was transferred to an assisted living facility with no further subjective concerns about the hallucinations.DiscussionPosterior cortical atrophy is a rare but disabling dementia syndrome. Our patient also had a complex visual and auditory hallucination leading to a delusional system which substantially decreased the quality of her life and was detrimental to her mental health. A literature search of OVID and PsycINFO yielded no reports for treatment of psychotic symptoms in patients with posterior cortical atrophy. Initiation of risperidone, 1 mg h.s., was well tolerated for this patient, significantly reduced her psychotic symptoms, and improved her quality of life.Neuropsychiatry Service, Department of Psychiatry, Maine MedicalCenter, Portland, MaineUniversity of Vermont College of Medicine, Burlington, VermontReferences1 . Mendez MF, Ghajarania M, Perryman KM: Posterior cortical atrophy: clinical characteristics and differences compared to Alzheimer’s disease. Dement Geriatr Cogn Disord 2002; 14:33–40Google Scholar2 . Victoroff J, Ross GW, Benson DF, et al: Posterior cortical atrophy: neuropathogical correlations. Arch Neurol 1994; 51: 269–274Google Scholar3 . Caine D: Posterior cortical atrophy: a review of literature. Neurocase 2004; 10:382–385Google Scholar4 . Tang-Wai DF, Graff-Radford NR, Boeve BF, et al: Clinical, genetic and neuropathological characteristics of posterior cortical atrophy. Neurology 2004; 63:1168–1174Google Scholar FiguresReferencesCited byDetailsCited ByDiagnostic evaluation and monitoring of patients with posterior cortical atrophyNeurodegenerative Disease Management, Vol. 9, No. 4 Volume 20Issue 3 Summer, 2008Pages 378-379 Metrics History Published online 1 July 2008 Published in print 1 July 2008

Die Rezeption Eugen Bleulers in Grossbritannien und Irland

This paper draws on 60 years of British medical journals and psychiatry textbooks to indicate chronological stages of reception of Eugen Bleuler in Britain and Ireland. It highlights diverging paces of reception between journals and textbooks and attempts to make sense of this in light of other historical factors, above all early difficulties in reception of Emil Kraepelin in these countries. Bleuler was already well known across English Channel before 1911, year his schizophrenia book appeared, although this would not be translated into English until 1950. The academic journals, Brain, The Journal of Mental Science, The British Medical Journal and The Lancet, contained numerous references, mainly positive, to Bleuler and his work, with one even regarding him as the sanest of living psychiatrists. The psychiatry textbooks, however, were slower to integrate Bleuler's contribution. This article argues that this is not to be understood in terms of tension on Continent between academic and asylum psychiatry, nor as result of Bleuler's placing Freud on a par with Kraepelin, but as a consequence of British reaction to Kraepelin's Dementia praecox concept. While Craig, Stoddart and Cole took account of Kraepelin's classification, Conolly Norman's negative judgement in British Medical Journal in 1904 was reflected in textbooks by Clouston, Mercier, Savage and Tredgold. Bleuler's new term Schizophrenia made its first textbook appearance in 1912 with Stoddart recognising that name had been suggested for Kraepelin's illness, but first breakthrough came in 1926 when Craig not only mentioned Bleuler's name for first time in a textbook, but applied Bleuler's approach to his own nosology. Since 1927, Henderson and Gillespie privileged Bleuler's wider and less ominous conception of Dementia praecox and, from mid-1950s, standard British textbook of Mayer-Gross, Slater and Roth generally presupposed Bleuler's contribution.

Does a Clerkship in Psychiatry Affect Medical Students' Attitudes Toward Psychiatry?

Does a Clerkship in Psychiatry Affect Medical Students' Attitudes Toward Psychiatry?

Discrepancy Between the 2007 Korean Medical Licensing Examination and the 2006 Learning Objectives for Medical Students

Abstract - Purpose: The purpose of this research was to evaluate the relationship between the 2007 Korean medical licensing examination (KMLE) and the 2006 Learning Objectives for Medical Students (LOMC) produced by the Association of Korean Medical Colleges’ Council of Deans. Methods: A total of 493 questions from the 2007 KMLE and the 2006 LOMC were used. The percentage and the frequency of each LOMC used in the 2007 KMLE were analyzed. The possibility of answering questions guided by the LOMC was analyzed. When questions could not be answered using the LOMC, we further categorized these questions into areas of medicine and specific causes. Results: A total of 669 (14.03%) learning objectives were used to solve questions from the 2007 KMLE. A learning objective was used a maximum of 5 times in the 2007 KMLE, and the percentages of one time, 2 times, 3 times, 4 times, and 5 times were 84.90%, 12.11%, 2.39%, 0.45%, and 0.15%, respectively. Four hundred six of 493 questions were solvable using the learning objectives, and 87 (17.65%) were not. When several steps were needed to solve a question, 15 questions (17.24%) could not be solved due to a lack of learning objectives for some of those steps. Overall, the 87 unsolvable questions were from internal medicine (37.9%), obstetrics & gynecology (14.9%), medical law (12.6%), pediatrics (10.3%), general surgery (9.2%), psychiatry (6.9%), and preventive medicine (1.1%). Questions difficult to solve specifically due to absent learning objectives were in the areas of treatment and procedure (29.67%), test and diagnosis (13.19%), symptoms (9.89%), pathophysiology (7.69%), complications (6.59%), and disease entity (6.59%). Conclusion: Discrepancy was observed between the 2007 KMLE and the 2006 LOMC. To solve this problem, the reorganization of both the KMLE and the LOMC based on a clear consensus of a primary care physician’s role is believed to be needed.

Pseudobulbar Palsy and Affect in a Case of Progressive Multifocal Leukoencephalopathy

Back to table of contents Previous article Next article LETTERFull AccessPseudobulbar Palsy and Affect in a Case of Progressive Multifocal LeukoencephalopathyKelly C. Graham M.D., M.S.David R. Spiegel M.D.,Kelly C. Graham M.D., M.S.Search for more papers by this authorDavid R. Spiegel M.D.Search for more papers by this author,Published Online:1 Jan 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Pseudobulbar palsy, with its neuropsychiatric manifestation of pathological laughing and crying or pseudobulbar affect, has been described in a variety of CNS illnesses. 1 We present, with interest, a case of Pseudobulbar palsy in a patient with progressive multifocal leukoencephalopathy, a complication of AIDS. 2Case ReportOur patient is a 39-year-old African American male whom we were asked to evaluate at our teaching hospital for an acute change of mental status. The patient’s past medical history was significant for AIDS.On initial presentation, vital signs and physical examination were essentially within normal limits. However, his neurological examination was significant for bilateral upper extremity hyperreflexia; lower extremity reflexes were difficult to elicit due to the patient’s supine position. He had a positive babinski sign on the right and down-going toes on the left. The jaw-jerk reflex and gag reflex were slightly increased.Our patient was treated for metabolic abnormalities and his mental status improved minimally. The patient received a magnetic resonance imaging (MRI) scan of the head which demonstrated several patches of signal abnormality involving subcortical white matter, brainstem, and cerebellum. The most likely diagnosis was postviral related demyelination due progressive multifocal leukoencephalopathy.His psychiatric examination was significant for monotone, nasal speech. His affect was labile and he would easily burst into tears and laugh inappropriately to questions. Cognitively, the patient was oriented times one. His working and short-term memory were impaired.In addition to a nasal dysarthria, our patient also experienced dysphagia. A barium swallow demonstrated aspiration of all consistency liquids. However, there were no abnormalities in relevant anatomy.Nonetheless, our patient’s medical condition worsened, and unfortunately he expired before we could attempt treatment of his pseudobulbar affect.Discussion This case demonstrates a clinical picture of pseudobulbar palsy in a patient suffering from progressive multifocal leukoencephalopathy due to AIDS. Given our patient’s clinical symptoms, plus pseudobulbar affect and MRI findings, he seemed to have pseudobulbar palsy. Historically, pseudobulbar palsy is considered in the setting of vascular disorders, neurodegenerative disorders, and other CNS diseases. 1 While various lesions of the CNS may present with pseudobulbar palsy, typically corticobulbar fibers are involved. 1 Similar to our patient’s MRI, progressive multifocal leukoencephalopathy includes multiple areas of demyelination, 3 further substantiating our impression of pseudobulbar palsy. Two predominate mechanisms have been proposed to explain pseudobulbar affect. One suggests disinhibition of the motor neurons controlling laughter and crying. Newer research suggests a reciprocal pathway exists between the cerebellum and the brainstem that adjusts laughter and crying responses, making them appropriate to context. 4 Pharmacologic interventions for pseudobulbar affect include the tricyclic antidepressants, serotonin reuptake inhibitors and a novel approach utilizing dextromethorphan and quinidine sulfate. Dextromethorphan, an N -methyl-D-aspartate receptor antagonist, inhibits glutamatergic transmission in the regions of the brainstem and cerebellum, which are hypothesized to be involved in pseudobulbar symptoms. Dextromethorphan acts as a sigma ligand, binding to the sigma-1 receptors that mediate the emotional motor expression. 5We feel this case report illustrates that pseudobulbar palsy and pseudobulbar affect should be considered across a variety of CNS conditions.Department of Psychiatry, Eastern Virginia Medical School, Norfolk, VirginiaReferences1 . Moore D, Jefferson J: Pseudobulbar palsy, in Handbook of Medical Psychiatry, 2nd ed. Mosby, 2004, pp 302–303Google Scholar2 . Mamidi A, DeSimone J, Pomerantz R: Central nervous system infections in individuals with HIV-1 infection. J Neurovirol 2002; 8:158–167Google Scholar3 . Mark A, Atlas S: Progressive multifocal leukoencephalopathy in patients with AIDS: appearance on MR images. Radiology 1989; 173:517–529Google Scholar4 . Keister GW: Pseudobulbar affect: keys to its cause and management. Applied Neurology 2006; 2(8)Google Scholar5 . Brooks BR, Thisted RA, Appel SH, et al: Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial. Neurology 2004; 63:1364–1370Google Scholar FiguresReferencesCited byDetailsCited byTreatment of pseudobulbar affect with citalopram in a patient with progressive multifocal leukoencephalopthyJournal of Clinical Neuroscience, Vol. 19, No. 1Pseudobulbar PalsyAmyotrophic Lateral Sclerosis, Vol. 11, No. 1-2 Volume 20Issue 1 Winter, 2008Pages 110-111 Metrics PDF download History Published online 1 January 2008 Published in print 1 January 2008

Pseudobulbar Palsy and Affect in a Case of Progressive Multifocal Leukoencephalopathy

Back to table of contents Previous article Next article LETTERFull AccessPseudobulbar Palsy and Affect in a Case of Progressive Multifocal LeukoencephalopathyKelly C. Graham M.D., M.S.David R. Spiegel M.D.,Kelly C. Graham M.D., M.S.Search for more papers by this authorDavid R. Spiegel M.D.Search for more papers by this author,Published Online:1 Jan 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Pseudobulbar palsy, with its neuropsychiatric manifestation of pathological laughing and crying or pseudobulbar affect, has been described in a variety of CNS illnesses. 1 We present, with interest, a case of Pseudobulbar palsy in a patient with progressive multifocal leukoencephalopathy, a complication of AIDS. 2Case ReportOur patient is a 39-year-old African American male whom we were asked to evaluate at our teaching hospital for an acute change of mental status. The patient’s past medical history was significant for AIDS.On initial presentation, vital signs and physical examination were essentially within normal limits. However, his neurological examination was significant for bilateral upper extremity hyperreflexia; lower extremity reflexes were difficult to elicit due to the patient’s supine position. He had a positive babinski sign on the right and down-going toes on the left. The jaw-jerk reflex and gag reflex were slightly increased.Our patient was treated for metabolic abnormalities and his mental status improved minimally. The patient received a magnetic resonance imaging (MRI) scan of the head which demonstrated several patches of signal abnormality involving subcortical white matter, brainstem, and cerebellum. The most likely diagnosis was postviral related demyelination due progressive multifocal leukoencephalopathy.His psychiatric examination was significant for monotone, nasal speech. His affect was labile and he would easily burst into tears and laugh inappropriately to questions. Cognitively, the patient was oriented times one. His working and short-term memory were impaired.In addition to a nasal dysarthria, our patient also experienced dysphagia. A barium swallow demonstrated aspiration of all consistency liquids. However, there were no abnormalities in relevant anatomy.Nonetheless, our patient’s medical condition worsened, and unfortunately he expired before we could attempt treatment of his pseudobulbar affect.Discussion This case demonstrates a clinical picture of pseudobulbar palsy in a patient suffering from progressive multifocal leukoencephalopathy due to AIDS. Given our patient’s clinical symptoms, plus pseudobulbar affect and MRI findings, he seemed to have pseudobulbar palsy. Historically, pseudobulbar palsy is considered in the setting of vascular disorders, neurodegenerative disorders, and other CNS diseases. 1 While various lesions of the CNS may present with pseudobulbar palsy, typically corticobulbar fibers are involved. 1 Similar to our patient’s MRI, progressive multifocal leukoencephalopathy includes multiple areas of demyelination, 3 further substantiating our impression of pseudobulbar palsy. Two predominate mechanisms have been proposed to explain pseudobulbar affect. One suggests disinhibition of the motor neurons controlling laughter and crying. Newer research suggests a reciprocal pathway exists between the cerebellum and the brainstem that adjusts laughter and crying responses, making them appropriate to context. 4 Pharmacologic interventions for pseudobulbar affect include the tricyclic antidepressants, serotonin reuptake inhibitors and a novel approach utilizing dextromethorphan and quinidine sulfate. Dextromethorphan, an N -methyl-D-aspartate receptor antagonist, inhibits glutamatergic transmission in the regions of the brainstem and cerebellum, which are hypothesized to be involved in pseudobulbar symptoms. Dextromethorphan acts as a sigma ligand, binding to the sigma-1 receptors that mediate the emotional motor expression. 5We feel this case report illustrates that pseudobulbar palsy and pseudobulbar affect should be considered across a variety of CNS conditions.Department of Psychiatry, Eastern Virginia Medical School, Norfolk, VirginiaReferences1 . Moore D, Jefferson J: Pseudobulbar palsy, in Handbook of Medical Psychiatry, 2nd ed. Mosby, 2004, pp 302–303Google Scholar2 . Mamidi A, DeSimone J, Pomerantz R: Central nervous system infections in individuals with HIV-1 infection. J Neurovirol 2002; 8:158–167Google Scholar3 . Mark A, Atlas S: Progressive multifocal leukoencephalopathy in patients with AIDS: appearance on MR images. Radiology 1989; 173:517–529Google Scholar4 . Keister GW: Pseudobulbar affect: keys to its cause and management. Applied Neurology 2006; 2(8)Google Scholar5 . Brooks BR, Thisted RA, Appel SH, et al: Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial. Neurology 2004; 63:1364–1370Google Scholar FiguresReferencesCited byDetailsCited ByPseudobulbar PalsyAmyotrophic Lateral Sclerosis, Vol. 11, No. 1-2 Volume 20Issue 1 Winter, 2008Pages 110-111 Metrics PDF download History Published online 1 January 2008 Published in print 1 January 2008

At APA Communication Is a Two-Way Street

Back to table of contents Previous article Next article From the PresidentFull AccessAt APA Communication Is a Two-Way StreetCarolyn Robinowitz, M.D.Carolyn RobinowitzSearch for more papers by this author, M.D.Published Online:7 Dec 2007https://doi.org/10.1176/pn.42.23.0003©Sylvia Johnson Photography 2007A major focus of my presidential year has been communication. APA has strengthened our public affairs efforts to improve interactions with national policymakers (Congress and the executive branch) as well as the media. Our Office of Minority and National Affairs has built alliances with the faith community (where many people first turn for help with mental health issues). Our workplace initiative, known as the Partnership for Workplace Mental Health, continues to reach employers (Psychiatric News, October 19), and research increasingly documents the impact of psychiatric care on businesses' bottom line.Knowing the importance of physicians in identifying and treating mental disorders, we have enhanced our work with the medical community both through organizations such as the AMA and the Council of Medical Specialty Societies (CMSS, the umbrella organization for the major medical specialties) and through specific educational and research efforts. These efforts are paying off; our communication and impact in the AMA continue to grow in effectiveness, and with the election of our medical director/CEO, Dr. Jay Scully, as president-elect of the CMSS, we have another strong voice in organized medicine.Our other important focus is communicating with members. It often has been stated that one of the best-kept secrets is what APA does to help psychiatrists care for patients. How do we best inform psychiatrists about issues that affect us and our patients? As a clinician in private practice, I constantly struggle to keep up with developments in science and policy. Reading Psychiatric News certainly makes this task easier, but I know all too well that time is precious and claimed by many other demands.Our Assembly can be of great assistance in the communication process. Its members are elected by local colleagues and serve as conduits both to and from the grass roots of the Association. As such, they are activists—bringing important matters to the attention of their colleagues and the national organization, as well as educators. Our Assembly members are knowledgeable about overall APA programs and efforts; they participate in advocacy, support professionalism, promote psychiatry's “causes,” and encourage and assist other psychiatrists to do so. They participate in outreach to medical students, psychiatry residents, and early career psychiatrists, serving as mentors in these psychiatrists' professional development. Many in the Assembly are active in their local medical societies, as well as other community programs.While APA works to be open and responsive, it is impossible to have a personal dialogue with each of our more than 38,000 members. Through Assembly representatives as well as Area trustees, individual psychiatrists have a more direct voice in our representational governance. Just as we visit and inform our legislators, so can members work with their elected Assembly representatives to raise questions and concerns, as well as initiate ideas and possible actions.As leaders, Assembly members have a responsibility to help set priorities and to respond to important questions: What are the issues that APA must address? What are the issues that only APA can address? What are the issues that APA should address? What are the issues that APA can address collaboratively with other organizations? Where should our energy and resources go? There are lots of wonderful opportunities and causes—many of which we share with other groups. But if we do not focus on our profession and our patients, who will? Consequently, we must make the difficult decision of allocating limited resources (we have not increased national dues for more than a decade) with our professional focus and priorities in mind, to do what we must do and what no one else can or will do.We are a large organization serving diverse interests and needs. We come from different ethnic and cultural backgrounds and work in different settings— private practice, community and state clinics and hospitals, academic medical centers, the military, and the VA. We also serve subspecialty populations— children and adolescents, the elderly, and people from diverse ethnic and cultural backgrounds—and care for those with a broad array of mental disorders including substance abuse. Each brings special concerns and demands for attention and resources.As the overarching organization for all of psychiatry, APA must address the important needs of the field, as well as work collaboratively with psychiatry's subspecialty organizations and interest groups to achieve our priorities. Call or e-mail your Assembly representatives to ensure that your voice informs our actions to serve our profession and our patients. ▪ ISSUES NewArchived

Viewpoint – Undergraduate psychiatry training: a Belfast Experience

As a medical student my enthusiastic psychiatry tutor was keen for me to clerk in a new admission. Equipped with a second hand text book in psychiatry and the main components of the mental state assessment summarised on the back of an envelope, I awaited my opportunity. The call came through that a patient with schizophrenia was to be admitted that evening. This prompted a quick revision of the clinical features of schizophrenia, ensuring I had a full understanding of delusions and knew the difference …

Psychodynamic Concepts Inherent in a Biopsychosocial Model of Care of Traumatic Injuries

The psychological issues facing medical and surgical patients suffering from traumatic injuries are numerous and varied. These injuries may occur in the settings of armed conflict, terrorist attack, natural disaster, or accident. The goal of preventing or decreasing significant and disabling psychiatric comorbidity can be the objective and assignment of a Psychiatry Consultation Liaison Service (PCLS) within the hospital setting. A comprehensive trauma consultation service could be designed to assist the entire medical complex in its response to various events. The needs of the patient, the patient's primary support group, and the medical staff must be considered in the development of a treatment strategy for the setting of a traumatic event. This article describes the integration of a Preventive Medical Psychiatry Service (PMP) at Walter Reed Army Medical Center (WRAMC) into a traditional PCLS. The PMP model is built upon the biopsychosocial model and psychodynamic developmental concepts.

Interest Surging in Electroconvulsive and Other Brain Stimulation Therapies

SAN DIEGO—A course of electroconvulsive therapy (ECT) every 9 or 10 months keeps her cyclic depression at bay, Kitty Dukakis said in an invited lecture at the annual meeting of the American Psychiatric Association (APA) here in May. Dukakis, the wife of former Massachusetts governor and 1988 Democratic presidential nominee Michael Dukakis, hopes her candor will help counter inaccurate and harrowing portrayals of ECT, such as those in the 1975 film One Flew Over the Cuckoo’s Nest, based on Ken Kesey’s 1962 novel. “Patients who are not helped by antidepressant medications and psychotherapy should not have to suffer for months, and in some cases, years, without ECT being an option,” noted Dukakis, who said she first received ECT in 2001, after experiencing deepening “bouts of despair” over 2 decades. Now 70 years old, she details her depression and its treatment, along with her earlier dependence on alcohol and amphetamine diet pills, in Shock: The Healing Power of Electroconvulsive Therapy (New York, NY: Avery; 2006), written with medical journalist Larry Tye. Dukakis’ willingness to speak out has helped boost public and physician awareness of ECT’s safety and efficacy, said Max Fink, MD, professor emeritus of psychiatry and neurology at the Stony Brook University School of Medicine, Stony Brook, NY. Results from 2 recent multisite collaborative studies also are prompting increased use of ECT worldwide, Fink noted. Remissions occurred with ECT in 86% of 394 patients with majordepressivedisorder completing the Consortium for Research in ECT study (Kellner CH et al. Arch Gen Psychiatry. 2006;63[12]:1337-1344) and in 55% of 290 patients completing a multisite study led by researchers at the New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, in New York City (Sackeim HA et al. JAMA. 2001;285[10]:1299-1307). These rates compare favorably with those obtained from use of antidepressant medications in similar patients. In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial— the first study to examine the effectiveness of medication and other treatment for patients who did not become symptom-free after initial medication— about 30% of patients initially treated with citalopram experienced a remission. Among 727 patients whose symptoms did not remit with citalopram or who could not tolerate it, remission occurred in about 1 in 4 patients given either bupropion, sertraline, or venlafaxine. Thus, STAR*D patients had about a 55% chance of achieving remission with their first or second course of medication (Rush AJ et al. N Engl J Med. 2006;354[12]:1231-1242). However, among 235 patients not reaching remission in the first 2 rounds, fewer than 1 in 5 became symptom-free after switching to a third medication (Fava M et al. Am J Psychiatry. 2006; 163[7]:1161-1172). Despite its utility, “ECT is widely stigmatized as a last-resort treatment,” said Fink, an ECT specialist for more than 50 years. The lack of required ECT instruction in US medical schools and psychiatry residency training programs, he said, has limited practitioners’ ability to recognize patients who may benefit from ECT (Fink M and Taylor MA. JAMA. 2007;298[3]:330-332). Major depressive disorder accounts for an estimated 70% to 80% of ECT use. National statistics for use of ECT are lacking; only a few states mandate reporting of this treatment.