Professional Articles

Final DSM 5 Approved by American Psychiatric Association

Sunday, December 2nd, 2012

Final DSM 5 Approved by American Psychiatric AssociationYesterday, the board of trustees of the American Psychiatric Association (APA) approved a set of updates, revisions and changes to the reference manual used to diagnose mental disorders. The revision of the manual, called the Diagnostic and Statistical Manual of Mental Disorders and abbreviated as the DSM, is the first significant update in nearly two decades.

Disorders that will be in the new DSM-5 — but only in Section 3, a category of disorders needing further research — include: Attenuated psychosis syndrome, Internet use gaming disorder, Non-suicidal self-injury, and Suicidal behavioral disorder. Section 3 disorders generally won’t be reimbursed by insurance companies for treatment, since they are still undergoing research and revision to their criteria.

So here’s a list of the major updates…

Social Touching: Building or Breaking Connections

Monday, November 12th, 2012

Social Touching: Building or Breaking ConnectionsDo you tend to be touchy-feely?  Are you comfortable with a pat on the back, a gentle hold on an elbow or a high-five?

When we touch, how often we touch and how we respond to touch is influenced by a wide variety of factors.  Each culture has varying norms about what is acceptable social touch. Families and social groups within a culture have their own norms. A 2012 study in the Journal of Personality and Social Psychology, for example, found that men are more likely to touch women than vice versa.

And each individual has a personality style that may influence their comfort level with touch in social situations.

Social touching (for example, a pat on the shoulder)  is an important part of our interactions with others.  It can be calming, create bonds, express concern and solidarity, reduce anxiety and provide reassurance.

How Psychology, Psychiatry Discriminate Against People with Mental Illness

Monday, November 5th, 2012

How Psychology, Psychiatry Discriminate Against People with Mental IllnessWhile attending the 28th Annual Rosalynn Carter Symposium on Mental Health Policy at The Carter Center last week, it occurred to me that mental health professionals are some of the worst when it comes to discriminating against people with mental illness.

They do this in insidious and subtle ways, suggesting a patient can’t do the things others without mental illness can do. Like hold down a job, get into independent housing, interact in social situations or even just go back to school and get a degree.

They also do this in more direct ways, by suggesting to their patients applying for a job or going back to school that, “If they don’t ask about mental illness, don’t volunteer that information.” Why not?

Why are mental health professionals helping to contribute to discrimination and stigma about mental illness by making these suggestions?

Forget Biden. Dr. Keith Ablow May Have…

Monday, October 15th, 2012

Forget Biden. Dr. Keith Ablow May Have...I have to wonder how helpful it truly is to be playing armchair psychiatrist, when you’ve never personally interviewed the person under discussion. Imagine all the things we could just hypothesize about any celebrity, based only upon a snippet of their public behavior (a snippet we carefully choose, of course).

There’s a profession that does something like this. They’re called publishers, and they publish tripe such as “Us Weekly” and “Star” magazine. They take a piece of gossip and write an entire story based upon nothing more than speculation, imagination and hype.

So I found it more than a little disappointing (but perhaps not surprising) to find a representative of the mental health profession, Dr. Keith Ablow, on Fox News Sunday night doing just that. He spoke during a “Medical A-Team” segment where a group of doctors talked about the vice-presidential debate.

Should a psychiatrist be discussing differential diagnoses of the Vice President of the United States — especially if they’ve never even met the man?

Why the APA is Losing Members

Friday, July 13th, 2012

Why the APA is Losing MembersThe American Psychological Association (APA) suffered a 7.6 percent loss of its members from 2010 to 2011 — from 91,306 to 84,339. While in recent years, the APA has suffered from smaller membership declines, this is the first time ever in the organization’s 120-year history it has suffered such a significant one-year decline in members.

Is this downward trend specific to the American Psychological Association, or are other professional organizations suffering similar losses?

And what’s to blame for this precipitous loss of members in a single year? A few factors come to mind.

Should Psychotherapy Notes Be a Part of Your Electronic Health Record?

Monday, June 25th, 2012

Should Psychotherapy Notes Be a Part of Your Electronic Health Record?A story last week caught my eye about a patient, Julie, who was surprised to discover that her psychotherapy notes became a part of her electronic health record at the hospital system that administered her care — Partners in Boston.

She found out that any doctor within the Partners system could access her record — including her sensitive psychotherapy notes — with no reason whatsoever. And she only discovered this privacy issue because her new internist initially refused to prescribe her needed medication because of “concern” about her psychiatric history — a history he had access to and read without the patient’s prior knowledge.

There’s a couple of problems here. But it’s a teaching moment for others implementing system-wide electronic health records. Psychotherapy notes enjoy special status in the health care community, and that special status should continue even in the age of electronic access.

The Hazards of Being a Therapist

Wednesday, June 6th, 2012

The Hazards of Being a TherapistI have been working in mental health for about 12 years. I listen to clients in crisis for many hours a day, providing support, empathy, interpretation and direction.

Therapists can easily lose track of their own issues, ignore their own problems, and at times have difficulty shutting off the therapeutic process.

In order to be a good therapist, it is necessary to take care of ourselves — our clients depend on it. Just because we know everything there is to know about stress management doesn’t mean that therapists can’t become mentally exhausted. If you are feeling “depersonalization” toward your clients or possibly yourself, you could be experiencing emotional fatigue.

Here are some ways that I like to keep balanced.

Doctors Don’t Grieve, Residents Don’t Sleep

Tuesday, May 29th, 2012

Doctors Dont Grieve, Residents Dont SleepMany doctors appear to believe they aren’t human — and don’t have normal human needs like the rest of us. At least according to two new studies recently released.

In an opinion piece published in Sunday’s New York Times, researcher Leeat Granek shares the results of two studies that suggest to her that, “Not only do doctors experience grief, but the professional taboo on the emotion also has negative consequences for the doctors themselves, as well as for the quality of care they provide.”

A different study released by the JAMA journal, Archives of Surgery, last week found that residents don’t get as much sleep as ordinary professionals get — which directly impacts their ability to concentrate and be mentally attentive.

Combined, these studies add to the picture that’s been painted for years by research — that doctors believe they are somehow “super human” and beyond the reach of normal human needs, for both their body and their mind. It’s a disturbing picture, and one that the medical education establishment needs to remedy sooner rather than later.

VA Ups Mental Health Clinicians by 1600, But Is It Enough?

Sunday, April 22nd, 2012

VA Ups Mental Health Clinicians by 1600, But Is It Enough?I applaud the U.S. Department of Veterans Affairs’ (VA) decision last week to increase its mental health staffing in facilities by nearly 10 percent across the board, adding up to 1,600 new clinicians — psychologists, psychiatrists, social workers and more. (My sources within the VA indicate most of these positions will be LPC and Master’s level clinicians — not psychologists or psychiatrists.)

It’s a good step forward as the military struggles with the hundreds of thousands of returning vets who have increasing mental health needs. Most of the new hires — about 1,400 — will be clinicians that work directly with vet patients.

But let’s also put this into some perspective, too. According to its website, the VA operates 172 hospitals across the United States, and 837 outpatient clinics. That’s 1,009 places where a vet can go to get help. That means that, on average, each clinic or hospital will get 1.4 new clinicians.

One and a half new clinicians per facility? Not nearly as impressive.

Publication Bias Again, This Time For Antipsychotics

Wednesday, March 21st, 2012

Publication Bias Again, This Time For AntipsychoticsAs we reported earlier today, new research has discovered that pharmaceutical companies withheld a handful of nonsignificant and negative data from publication when working to get the U.S. Food and Drug Administration (FDA) to approve atypical antipsychotics. However, the problem was significantly less severe than the publication bias researchers found when looking at antidepressants.

Antidepressants have been especially hard hit when looking at the FDA pre-approval research. In fact, in Lesley Stahl’s recent 60 Minutes report on antidepressant research, she walked away completely baffled by the meaning of it all. What does it mean when researchers find such negative findings that were never published?

Let’s find out…

How the Public is Being Misinformed about Grief

Tuesday, February 28th, 2012

How the Public is Being Misinformed about Grief“Have the psychiatrists gone mad? — those who weren’t crazy to begin with! They want to turn grief into a disease!”

This might well be the attitude of many in the general public, having read the misleading news coverage of a debate over the DSM-5 — the still-preliminary diagnostic classification of mental disorders, often referred to as “psychiatry’s Bible.” Now, I am no fan of the DSM model of diagnosis — in fact, if the DSM is the “bible,” I’m something of a heretic. In my view, the DSM’s superficial symptom checklists are great for research purposes, but not very useful for most clinicians or patients.

Nevertheless, I don’t like seeing the work of my DSM-5 colleagues misrepresented. So when I see bogus headlines like, “Grief Could Join List of Disorders” in the usually circumspect New York Times, I cringe.

Before discussing the arcane debate over the “bereavement exclusion,” it’s important to understand what most psychiatrists really believe about grief, bereavement, and depression.

Diagnosis of a DSM 5 News Cycle

Sunday, February 12th, 2012

Diagnosis of a DSM 5 News CycleAs I was sitting around catching up on some mental health news on Saturday, I inadvertently stumbled upon another manufactured news cycle about the DSM 5. Considering no new significant research findings were released in the past week on the DSM-5 revision efforts, I was a little surprised.

This latest fake news cycle started on Thursday, apparently with the release of a Reuters news story from Kate Kelland. Kelland notes the newest concern comes from “Liverpool University’s Institute of Psychology at a briefing in London about widespread concerns over the manual.” There’s no link to the briefing. And I’m not sure what a “briefing” is — a press conference? (And since when is a press conference a news item? It’s not really equivalent to a new research study, is it?)

Kelland fails to note that Europe and the U.K. don’t actually use the DSM to diagnose mental disorders — it’s a U.S. reference manual for mental disorders diagnosis. So while it’s nice that some Europeans are expressing concern about this reference text, their concern isn’t exactly much relevant. Context is everything, and Reuters failed to provide any useful context in that article.

Sadly, Reuters is a brand name. And once you write an article under that brand name, it cascades down an entire news cycle. Let’s follow it for fun!

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