October 27th, 2010 by AnneHansonMD in Better Health Network, Health Policy, News, Opinion, Research
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For new readers, it’s my tradition to put up posts summarizing tidbits I picked up at the annual American Academy of Psychiatry and Law (AAPL) conference. It’s random, it’s not explained in detail, but it’s stuff I thought was interesting.
The conference started out with a keynote speech by AAPL President Stephen Billick. The title of his talk was “Be True To Psychiatry.” His point was that forensic psychiatrists are clinicians first, and that even a forensic evaluation can have therapeutic effects. He cited many examples in his practice in which a criminal or civil evaluation had potential beneficial “side effects” regardless of the forensic opinion. His main point: the forensic psychiatrist’s obligation to be neutral and objective does not preclude kindness. A point well taken, and appreciated.
A session on suicide risk assessment gave a very nice illustration of the basic problem inherent in these assessments: even assuming an “ideal” case situation with a “perfect” psychiatrist, a thorough suicide risk assessment would take four hours. Risk assessment is time consuming and inherently will be incomplete. We make the best decisions we can based on the limited data we have at the time. Read more »
*This blog post was originally published at Shrink Rap*
October 17th, 2010 by Dinah Miller, M.D. in Better Health Network, Book Reviews, Opinion, True Stories
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I just finished reading Dr. Gary Small’s book, The Naked Lady Who Stood On Her Head.
In the final chapter of the book, Dr. Small talks about his mentor, friend, and father figure who’s mentioned throughout the book. The mentor approaches him on the golf course, where they meet to talk, and says he needs psychotherapy and Small is the man to do it. The author is surprised, hesitant, and a bit uncomfortable with the demand (it comes as more than a request.) His wife likens it to the need for a plumber or a dentist, and Dr. Small takes on the task. The mentor calls all the shots: Where the meetings will be, what pastry they will eat, the form of his payment. The author initially misses the diagnosis and uses this as an example of how one can be blinded.
So is it okay for a friend to treat a friend? Read more »
*This blog post was originally published at Shrink Rap*
October 11th, 2010 by Dinah Miller, M.D. in Better Health Network, Health Policy, Opinion
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Look, he came back! Guest blogger Mitchell Newmark, M.D., put on his armor and came to blog with us again.
The Relative Unimportance of Diagnosis In Psychiatry
As we will soon be witness to the emergence of DSM-V, the new rule book for psychiatric diagnosis, I am reminded of all the pitfalls of diagnosis in psychiatry. In other fields of medicine, diagnosis is based primarily on etiology, with objective findings, rather than on symptoms alone, as it is in psychiatry. When you go to your internist with stomach pain, there’s an endoscopy to look for ulcers, a sonogram to look for gall stones, a blood test to look for hepatitis. But in psychiatry, there is no CT scan to check for bipolar disorder, no blood test to assess if the patient has schizophrenia, no spinal tap to check for major depression.
For the psychiatric community at large, diagnosis is important for many reasons. It helps doctors sort out patients so that clinical trials can be conducted on similar groups of patients. It enhances communication among psychiatrists when behavioral, affective and cognitive symptoms can be categorized. But for the individual patient, it is less useful. Some patients fit nicely into DSM categories, and others don’t. There are many patients who have unique combinations of symptoms across several diagnostic criteria. This leads to assigning multiple diagnoses, and confusing the treatment picture. Read more »
*This blog post was originally published at Shrink Rap*
October 6th, 2010 by Dinah Miller, M.D. in Better Health Network, Health Tips, Opinion
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“I have bipolar disorder. Can I be a doctor?” One of our readers asked this. It’s one of those questions to which there is no real answer.
Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn (organic chem anyone?) and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: Arrogant supervisors, irritable colleagues, sick people who may not be charming and who may, in their distress, be downright nasty. You have to tolerate a militaristic order and be willing to work with a system that may be very difficult, wrong, and demand your obedience in ways that may be uncomfortable. (Oh, I am so happy to no longer be a medical student or a resident in training.)
So can you do it with bipolar disorder? Can you do it with diabetes? Can you do it with attention deficit problems? Can you do it if you’re disorganized or ugly? Read more »
*This blog post was originally published at Shrink Rap*
September 24th, 2010 by Dinah Miller, M.D. in Better Health Network, News, Opinion, Research
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In psychiatry, we’ve had a hard time drawing precise links between brain pathology and psychiatric disorders. We can do it for groups of people: “Disease X” is associated with changes in brain structure of “Brain Area Y” or metabolic changes in “Brain Area Z.” But it’s groups, not individuals, and it’s an association, not a cause-and-effect, or a definite. We still can’t use this information for diagnosis, and there are still patients with any given psychiatric diagnoses who will have brains where “Area Y” is the same size as those without the disorder. We’re learning.
From what I read in this New York Times article, Owen Thomas was a bright, talented young man with no history of psychiatric disorder and no history of known concussion. In April, he committed suicide — a tragedy beyond words.
Sometime people commit suicide and everyone is left to wonder: There was no depression, no obvious precipitant, no note left behind, and every one is left to wonder why. The guilt toll on the survivors is enormous, as is the grief for their families and communities. In this case, according to the Philadelphia Inquirer, the young man was apparently struggling with the stress of difficult school work and concerns about his team and employment.
Owen’s family donated his brain to Boston University’s Center for the Study of Traumatic Encephalopathy. They discovered that Owen’s brain showed damage similar to that seen in older NFL players — he had a condition called chronic traumatic encephalopathy. Read more »
*This blog post was originally published at Shrink Rap*
