Medically Unexplained Symptoms: Barriers to Effective Treatment When Nothing Is the Matter
Abstract: Patients with symptoms that elude medical explanation are a perennial challenge to practicing physicians of all disciplines. Articles appear virtually monthly advising physicians how to care for them. Efforts at postgraduate education have attempted to ameliorate the situation but have shown limited or disappointing results at best. Physicians continue either to avoid these patients or to resort to a “seat-of-the-pants” approach to management. Literature on patients with medically unexplained symptoms, along with extensive experience consulting with primary care physicians, suggests that it is not primarily l...
Source: Harvard Review of Psychiatry - November 1, 2015 Category: Psychiatry Tags: Perspectives Source Type: research
Consumer Information and Treatment Resources for Posttraumatic Stress Disorder: Within Reach but Not Grasp
Abstract: In the context of multiple treatment options for posttraumatic stress disorder (PTSD) and a large, growing need for consumer information regarding accessible and effective treatments, this article identifies and reviews available information and treatment resources. Multiple search strategies identified a suite of information sources, including meta-analyses and systematic reviews of PTSD treatments, the program evaluation and implementation literature, the economics literature, Internet sites, and other resources for veteran and civilian consumers. Resources were evaluated with regard to their target audiences, ...
Source: Harvard Review of Psychiatry - November 1, 2015 Category: Psychiatry Tags: Perspectives Source Type: research
Virginia Tech as a Sentinel Event: The Role of Psychiatry in Managing Emotionally Troubled Students on College and University Campuses
This article reviews the role of psychiatry in colleges and universities, and argues that psychiatrists are significantly underutilized as consultants and educators in managing emotionally troubled students. Focusing on the 2007 Virginia Tech mass shooting case as a sentinel event, the article outlines mental health issues facing post-secondary institutions and legal issues related to psychiatric services, including the following: the increased need for psychiatric services on campus; communication challenges among campus groups involved in managing high-risk students; efforts to balance patient confidentiality with public...
Source: Harvard Review of Psychiatry - November 1, 2015 Category: Psychiatry Tags: Perspectives Source Type: research
Parental and Child Characteristics Related to Early-Onset Disordered Eating: A Systematic Review
In conclusion, characteristics related to early-onset disordered eating have mainly been explored with a cross-sectional design. Full understanding of causal pathways will require good-quality longitudinal studies designed to address the influence of parental eating behaviors, mental and physical health, family interactions, and child growth patterns. (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - November 1, 2015 Category: Psychiatry Tags: Review Source Type: research
Interventions for Neuropsychiatric Symptoms in Neurocognitive Impairment Due to Alzheimer’s Disease: A Review of the Literature
Abstract: Neurocognitive impairment due to Alzheimer’s disease (previously termed Alzheimer’s dementia) (AD) is the most common form of cognitive impairment worldwide. Given the anticipated increase in the population aged 65 and over, the prevalence of persons with AD is expected to increase exponentially during the next 30 years. Noncognitive neuropsychiatric symptoms (NPS) commonly occur in AD and are associated with adverse outcomes for patients and their caregivers. This review summarizes randomized, controlled trials (RCTs) published between 2004 and 2014 with a primary outcome measure of change in symptom severit...
Source: Harvard Review of Psychiatry - September 1, 2015 Category: Psychiatry Tags: Reviews Source Type: research
Mild Neurocognitive Disorder: An Old Wine in a New Bottle
This article reviews the DSM-5 criteria for mild NCD, compares them with the Key International Symposium MCI criteria, and discusses the pros and cons of the mild NCD construct. (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - September 1, 2015 Category: Psychiatry Tags: Reviews Source Type: research
Psychosis in Later Life: A Review and Update
Abstract: Psychosis is relatively common in later life and can present in a wide variety of contexts, including early-onset and late-onset schizophrenia, delusional disorder, mood disorders, and various dementias. It can also occur as the result of numerous medical and neurological diseases and from the use of certain medications. Although identifying the cause of psychosis in older patients can be challenging, the unique clinical features associated with the different disorders can help in making the diagnosis. Accurate diagnosis of psychosis in older populations is essential, as its treatment varies depending on the cont...
Source: Harvard Review of Psychiatry - September 1, 2015 Category: Psychiatry Tags: Reviews Source Type: research
Depression in Older Adults: A Palliative Medicine Perspective
This article aims to discuss the rapidly growing field of palliative medicine and its unique approach to treating depression in older adults. (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - September 1, 2015 Category: Psychiatry Tags: Perspectives Source Type: research
Treating Anxiety Disorders in Older Adults: Current Treatments and Future Directions
We present material on the application of the Research Domain Criteria (RDoC) model to geriatric anxiety. Finally, we describe optimal management strategies of anxiety disorders. (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - September 1, 2015 Category: Psychiatry Tags: Reviews Source Type: research
DSM-5 and Mental Disorders in Older Individuals: An Overview
This article briefly describes the process leading up to DSM-5 and the main changes from the previous version (DSM-IV) that would be of interest to a geriatric psychiatrist. The changes in the areas of schizophrenia, bipolar disorder, depressive disorders, and anxiety disorders have been many, but the majority of them are minor and unlikely to have major treatment implications. The classification of neurocognitive disorders, however, has seen a major revision and elaboration in comparison to DSM-IV; of special note is the introduction of “mild and major neurocognitive disorders,” the latter equated with dementia. A com...
Source: Harvard Review of Psychiatry - September 1, 2015 Category: Psychiatry Tags: Reviews Source Type: research
The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities
We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potent...
Source: Harvard Review of Psychiatry - September 1, 2015 Category: Psychiatry Tags: Perspectives Source Type: research
Introduction
No abstract available (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - September 1, 2015 Category: Psychiatry Tags: Introduction Source Type: research
Improving Psychiatry Residents’ Attitudes Toward Individuals Diagnosed with Substance Use Disorders
Special attention needs to be paid to the attitudes of psychiatry residents toward individuals diagnosed with substance use disorders. The attitudes of trainees may be worse toward these individuals than toward individuals with other diagnoses, and these attitudes may worsen over time. While psychiatry residencies are increasingly teaching residents about how to diagnosis and treat individuals diagnosed with substance use disorders, more attention needs to be paid to educating residents about common attitudes toward these individuals. We recommend that psychiatry residency programs start with basic educational didactics an...
Source: Harvard Review of Psychiatry - July 1, 2015 Category: Psychiatry Tags: Education Source Type: research
Intensely Suicidal Behavior with a First Manic Episode
No abstract available (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - July 1, 2015 Category: Psychiatry Tags: Clinical Challenge Source Type: research
Fear and the Defense Cascade: Clinical Implications and Management
Abstract: Evolution has endowed all humans with a continuum of innate, hard-wired, automatically activated defense behaviors, termed the defense cascade. Arousal is the first step in activating the defense cascade; flight or fight is an active defense response for dealing with threat; freezing is a flight-or-fight response put on hold; tonic immobility and collapsed immobility are responses of last resort to inescapable threat, when active defense responses have failed; and quiescent immobility is a state of quiescence that promotes rest and healing. Each of these defense reactions has a distinctive neural pattern mediated...
Source: Harvard Review of Psychiatry - July 1, 2015 Category: Psychiatry Tags: Perspectives Source Type: research
