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Do You Think You Have OCD?

When I leave for work in the morning, I go through my precommute checklist. Train pass, check. Wallet, check. Coffee mug, check. Smart phone, check. Keys to the house, check. Only when I’m sure that I have everything I need do I open the door and head outside.

Sometimes I worry that this morning routine is becoming too much of a ritual. Is it possible that I have obsessive-compulsive disorder (OCD for short)?

Probably not. The fact that I am able to get out the door every morning means that my daily ritual isn’t interfering with my ability to function, says Dr. Jeff Szymanski, a clinical instructor in psychology at Harvard Medical School.

You have OCD when obsessions and compulsive behavior Read more »

*This blog post was originally published at Harvard Health Blog*

Psychiatrists Must Maintain Their Distance

In the Clinical Encounters case featured here two days ago, I presented the story of a psychiatrist who goes for a urological procedure and discovers that one of his former patients is the nurse assisting.  People wrote in to suggest ways he should handle this awkward situation and I was struck by the idea that some suggested he tell the urologist that he knows the nurse in a social setting (because he can’t tell the other doc that the nurse was his psychiatric patient) and the assumption that the urologist would be understanding, and that perhaps the urologist should have policies in place in case of such events.

Do surgeons think this way? Read more »

*This blog post was originally published at Shrink Rap*

How Effective Are Antidepressants?

Antidepressant drugs have been getting a bad rap in the media. I’ll just give 3 examples:

  • On the Today show, prominent medical expert :-) Tom Cruise told us Brooke Shields shouldn’t have taken these drugs for her postpartum depression.
  • In Natural News, “Health Ranger” Mike Adams accused pharmaceutical companies and the FDA of covering up negative information about antidepressants, saying it would be considered criminal activity in any other industry.
  • And an article in Newsweek said  “Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse.”

Yet psychiatrists are convinced that antidepressants work and are still routinely prescribing them for their patients. Is it all a Big Pharma plot? Who ya gonna believe? Inquiring minds want to know:

  • Are antidepressants more effective than placebo?
  • Has the efficacy of antidepressants been exaggerated?
  • Is psychotherapy a better treatment choice?

The science-based answers to the first two questions are Read more »

*This blog post was originally published at Science-Based Medicine*

Psychiatrist Reviews “Crazy” Book: Finds Some Genuineness Behind Author’s Bravado

Rob Dobrenski, PhD. is a psychologist who blogs over on ShrinkTalk.net.  He’s written a book about what it’s like to be a psychology graduate student, a psychotherapy patient, and a psychologist.  Oh, we like the folks who go from Shrink blog to Shrink book — it somehow feels familiar — and so I agreed to read his book: Crazy: Tales on and Off the Couch.

So bear with me while I tell you that the book rubbed me wrong at the outset.  Dr. Dobrenski begins by saying something to the effect that he describes things that all shrinks feel, and if they say they don’t, they aren’t being honest.  I really hate it when people tell me what I feel.  It’s like saying that Prozac made your depression better and if it didn’t, then you just didn’t recognize it.  And then the book gets off on a provocative start — Rob discovers that many people in his life, from a patient, to a colleague, to himself — are “f***ing crazy.” The asterisks are mine. Dr. Dobrenski had no trouble using the word — I counted 19 times in the 39 pages, including in direct quotes of discussions he has with both a patient and one of his supervisors.  Not in a million years.  I wasn’t sure what the point was.  To let people know he knows obscene words?  To be Read more »

*This blog post was originally published at Shrink Rap*

Bad Medical Practices On Television

I watch some TV (and essentially no commercials, thanks to DVRs) and have been enjoying some shows: Necessary Roughness and Covert Affairs. Yes, put a reasonably attractive female in the lead role of a show with some action and I might watch. Demographic shocker.

So, within the last two days I saw one completely egregious professional breach, and one exercise of pretty awful medical judgement (in an ED, which makes it way worse for me), and I will now outline my concerns/gripes.

(Yes, I’m aware they’re TV shows, and are therefore not reality. What I’m unhappy with is the glib way in which these terrible decisions played out, like it’s not a big deal to act against the interests of your patient, even especially, on TV). (I think TV behavior, not the cartoon violence but the everyday mundane stuff, influences how regular people think, which is why I’m writing this: so the zero regular people who watch TV and read this blog have something to consider).

So the Necessary Roughness (episode Anchor Roughness) thing: (Background): the protagonist is a female psychologist hired by a football team to get their star player “TK” (with more than a mild resemblance to “TO“, the former 49ers Eagles Cowboys Bills Browns wide receiver) playing and catching; it’s a TV troubled relationship. (Player is aware she works for the team). In the show TK threatens to leave the team, is convinced not to leave in a bluff by the team to send him to a cold climate, and TK decides to stay with the team. In the denouement, it is revealed that the whole idea for the bluff was the psychologists’ idea, for which she was praised by the team.

Umm, I have an objection. Read more »

*This blog post was originally published at GruntDoc*

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When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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