James Randolph Hillard, MD

Starting with this issue, Current Psychiatry is being sent to more than 3,000 advanced practice psychiatric nurses, who join the 37,000 psychiatrists who already receive it. The same “news you can use” that has made Current Psychiatry the most highly read journal among psychiatrists should help psychiatric nurses as well.

Advanced practice nurses have prescriptive authority in 49 states, and many prescribe on their own signatures. Laws governing their prescribing vary from state to state, as do their titles, including nurse practitioner (NP), clinical nurse specialist (CNS), advanced practitioner of nursing (APN), and perhaps a dozen others. All are registered nurses who have completed the additional graduate-level education and training required to diagnose and treat psychiatric disorders. [For more information, see the special report, “The Role of Advanced Practice Psychiatric Nurses,” at www.currentpsychiatry.com.]

In the past, organized psychiatry has systematically opposed nurses prescribing, and I believe that opposition was a bad thing. Nurses and physicians have been partners in caring for patients with mental illness for more than a century. We are members of distinct health professions but share the same goal: to ensure that our patients receive the best care.

Both professional groups have the necessary biologically-based training to appropriately prescribe the wonderful—and potentially dangerous—medications used in psychiatric practice. Both groups are committed to a program of lifelong learning, and both need unbiased, clinically relevant sources of therapeutic information—such as Current Psychiatry.

We are all in this together. Welcome, welcome.

Starting with this issue, Current Psychiatry is being sent to more than 3,000 advanced practice psychiatric nurses, who join the 37,000 psychiatrists who already receive it. The same “news you can use” that has made Current Psychiatry the most highly read journal among psychiatrists should help psychiatric nurses as well.

Advanced practice nurses have prescriptive authority in 49 states, and many prescribe on their own signatures. Laws governing their prescribing vary from state to state, as do their titles, including nurse practitioner (NP), clinical nurse specialist (CNS), advanced practitioner of nursing (APN), and perhaps a dozen others. All are registered nurses who have completed the additional graduate-level education and training required to diagnose and treat psychiatric disorders. [For more information, see the special report, “The Role of Advanced Practice Psychiatric Nurses,” at www.currentpsychiatry.com.]

In the past, organized psychiatry has systematically opposed nurses prescribing, and I believe that opposition was a bad thing. Nurses and physicians have been partners in caring for patients with mental illness for more than a century. We are members of distinct health professions but share the same goal: to ensure that our patients receive the best care.

Both professional groups have the necessary biologically-based training to appropriately prescribe the wonderful—and potentially dangerous—medications used in psychiatric practice. Both groups are committed to a program of lifelong learning, and both need unbiased, clinically relevant sources of therapeutic information—such as Current Psychiatry.

We are all in this together. Welcome, welcome.

Starting with this issue, Current Psychiatry is being sent to more than 3,000 advanced practice psychiatric nurses, who join the 37,000 psychiatrists who already receive it. The same “news you can use” that has made Current Psychiatry the most highly read journal among psychiatrists should help psychiatric nurses as well.

Advanced practice nurses have prescriptive authority in 49 states, and many prescribe on their own signatures. Laws governing their prescribing vary from state to state, as do their titles, including nurse practitioner (NP), clinical nurse specialist (CNS), advanced practitioner of nursing (APN), and perhaps a dozen others. All are registered nurses who have completed the additional graduate-level education and training required to diagnose and treat psychiatric disorders. [For more information, see the special report, “The Role of Advanced Practice Psychiatric Nurses,” at www.currentpsychiatry.com.]

In the past, organized psychiatry has systematically opposed nurses prescribing, and I believe that opposition was a bad thing. Nurses and physicians have been partners in caring for patients with mental illness for more than a century. We are members of distinct health professions but share the same goal: to ensure that our patients receive the best care.

Both professional groups have the necessary biologically-based training to appropriately prescribe the wonderful—and potentially dangerous—medications used in psychiatric practice. Both groups are committed to a program of lifelong learning, and both need unbiased, clinically relevant sources of therapeutic information—such as Current Psychiatry.

We are all in this together. Welcome, welcome.

When Confucius was asked what he would do first should he become minister of the Kingdom of Wei, he replied: “What is necessary is to rectify names.” He further stated, “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot be carried on to success” (from The Analects of Confucius, James R. Ware translation, 1980: book 13, verse 3).

I am reminded of this aphorism by Dr. Leslie Citrome’s article, “Treatment-resistant schizophrenia: What role for mood stabilizers?”. This article highlights several psychotropic classes whose names badly need rectification, including “mood stabilizers,” “anticonvulsants,” and “antipsychotics.”

A compound’s first use tends to give it its functional name. Sodium valproate was first used to treat seizures, so it is called an anticonvulsant. Lithium was first used to stabilize mood, so it is called a mood stabilizer. Sometimes valproate is now called a mood stabilizer as well. As Dr. Citrome demonstrates, both compounds also may have efficacy as adjuncts in treating schizophrenia. So do we call them antipsychotics, too?

Each compound has a variety of effects, of course, and we start to diverge from the “truth of things” when we get locked into thinking of a compound in just one way. We also make it less likely that affairs can “be carried on to success” for our patients.

When Confucius was asked what he would do first should he become minister of the Kingdom of Wei, he replied: “What is necessary is to rectify names.” He further stated, “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot be carried on to success” (from The Analects of Confucius, James R. Ware translation, 1980: book 13, verse 3).

I am reminded of this aphorism by Dr. Leslie Citrome’s article, “Treatment-resistant schizophrenia: What role for mood stabilizers?”. This article highlights several psychotropic classes whose names badly need rectification, including “mood stabilizers,” “anticonvulsants,” and “antipsychotics.”

A compound’s first use tends to give it its functional name. Sodium valproate was first used to treat seizures, so it is called an anticonvulsant. Lithium was first used to stabilize mood, so it is called a mood stabilizer. Sometimes valproate is now called a mood stabilizer as well. As Dr. Citrome demonstrates, both compounds also may have efficacy as adjuncts in treating schizophrenia. So do we call them antipsychotics, too?

Each compound has a variety of effects, of course, and we start to diverge from the “truth of things” when we get locked into thinking of a compound in just one way. We also make it less likely that affairs can “be carried on to success” for our patients.

When Confucius was asked what he would do first should he become minister of the Kingdom of Wei, he replied: “What is necessary is to rectify names.” He further stated, “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot be carried on to success” (from The Analects of Confucius, James R. Ware translation, 1980: book 13, verse 3).

I am reminded of this aphorism by Dr. Leslie Citrome’s article, “Treatment-resistant schizophrenia: What role for mood stabilizers?”. This article highlights several psychotropic classes whose names badly need rectification, including “mood stabilizers,” “anticonvulsants,” and “antipsychotics.”

A compound’s first use tends to give it its functional name. Sodium valproate was first used to treat seizures, so it is called an anticonvulsant. Lithium was first used to stabilize mood, so it is called a mood stabilizer. Sometimes valproate is now called a mood stabilizer as well. As Dr. Citrome demonstrates, both compounds also may have efficacy as adjuncts in treating schizophrenia. So do we call them antipsychotics, too?

Each compound has a variety of effects, of course, and we start to diverge from the “truth of things” when we get locked into thinking of a compound in just one way. We also make it less likely that affairs can “be carried on to success” for our patients.

Here’s a horrifying thought: What if psychiatrists were internists? Only by historical accident is psychiatry its own specialty, separate from internal medicine.

Our 19th- and 20th-century predecessors practiced in state mental hospitals and treated most patients with psychotherapy rather than drugs. Today, most inpatient psychiatry is practiced in general hospitals, and we do at least as much pharmacotherapy as psychotherapy. If psychiatry were getting started today, it probably would an internal medicine subspecialty.

When I was in medical school, one psychiatry attending had been a surgeon before his psychiatry residency. When I said his two specialties seemed very different, his response was, “Not really.” Psychiatrists and surgeons “treat patients,” whereas other specialists—say, internists—prefer to “solve problems.”

During my residency, the surgeons called internists “fleas” because all they seemed to do was hop around in packs drawing blood. This stereotype—if it was ever true—is probably less accurate today, with so many internists becoming proceduralists rather than cognitive specialists.

But still . . . if we were internists, we undoubtedly would do more diagnostic tests. Psychiatry’s standard of care is to do lab tests when patients are hospitalized but very seldom in outpatient settings. If we were internists, we would do lab tests before starting any outpatient on any treatment. Everyone would get an extensive “workup” to “rule out” numerous highly improbable diagnoses.

The article in this issue by Drs. Richard Rosse and Stephen Deutsch addresses intelligent lab testing before starting patients on psychotropics. I do not want to give away the ending, but these authors recommend more testing than most of us do and less than we probably would be doing if we were—horror of horrors!—internists.

Here’s a horrifying thought: What if psychiatrists were internists? Only by historical accident is psychiatry its own specialty, separate from internal medicine.

Our 19th- and 20th-century predecessors practiced in state mental hospitals and treated most patients with psychotherapy rather than drugs. Today, most inpatient psychiatry is practiced in general hospitals, and we do at least as much pharmacotherapy as psychotherapy. If psychiatry were getting started today, it probably would an internal medicine subspecialty.

When I was in medical school, one psychiatry attending had been a surgeon before his psychiatry residency. When I said his two specialties seemed very different, his response was, “Not really.” Psychiatrists and surgeons “treat patients,” whereas other specialists—say, internists—prefer to “solve problems.”

During my residency, the surgeons called internists “fleas” because all they seemed to do was hop around in packs drawing blood. This stereotype—if it was ever true—is probably less accurate today, with so many internists becoming proceduralists rather than cognitive specialists.

But still . . . if we were internists, we undoubtedly would do more diagnostic tests. Psychiatry’s standard of care is to do lab tests when patients are hospitalized but very seldom in outpatient settings. If we were internists, we would do lab tests before starting any outpatient on any treatment. Everyone would get an extensive “workup” to “rule out” numerous highly improbable diagnoses.

The article in this issue by Drs. Richard Rosse and Stephen Deutsch addresses intelligent lab testing before starting patients on psychotropics. I do not want to give away the ending, but these authors recommend more testing than most of us do and less than we probably would be doing if we were—horror of horrors!—internists.

Here’s a horrifying thought: What if psychiatrists were internists? Only by historical accident is psychiatry its own specialty, separate from internal medicine.

Our 19th- and 20th-century predecessors practiced in state mental hospitals and treated most patients with psychotherapy rather than drugs. Today, most inpatient psychiatry is practiced in general hospitals, and we do at least as much pharmacotherapy as psychotherapy. If psychiatry were getting started today, it probably would an internal medicine subspecialty.

When I was in medical school, one psychiatry attending had been a surgeon before his psychiatry residency. When I said his two specialties seemed very different, his response was, “Not really.” Psychiatrists and surgeons “treat patients,” whereas other specialists—say, internists—prefer to “solve problems.”

During my residency, the surgeons called internists “fleas” because all they seemed to do was hop around in packs drawing blood. This stereotype—if it was ever true—is probably less accurate today, with so many internists becoming proceduralists rather than cognitive specialists.

But still . . . if we were internists, we undoubtedly would do more diagnostic tests. Psychiatry’s standard of care is to do lab tests when patients are hospitalized but very seldom in outpatient settings. If we were internists, we would do lab tests before starting any outpatient on any treatment. Everyone would get an extensive “workup” to “rule out” numerous highly improbable diagnoses.

The article in this issue by Drs. Richard Rosse and Stephen Deutsch addresses intelligent lab testing before starting patients on psychotropics. I do not want to give away the ending, but these authors recommend more testing than most of us do and less than we probably would be doing if we were—horror of horrors!—internists.

Psychiatrists seem to worry more than other physicians about malpractice claims, even though other specialists face greater numbers of claims and more-astronomical awards. One source of our anxiety is psychiatry’s difficulty in defining “standard of care.”

Twenty years ago, patients with identical symptoms could receive very different treatments, depending on the treating psychiatrists’ philosophies. Our standard of care is better-defined today, but we still may offer a suicidally depressed patient a broader range of treatments than other specialists offer patients with life-threatening illnesses.

We also worry because of the greater “creativity” personal injury lawyers can use in making claims against us, compared with other specialties. For example, most claims against a diagnostic radiologist are limited to failure to diagnose something. Psychiatrists can be subject to claims for not only failing to diagnose or treat mental disorders but also for failing to restrain patients who harm themselves or to protect people we have never met from harm our patients may cause.

To address these concerns, we obtained permission to abstract malpractice cases of interest to psychiatrists from the newsletter Medical Malpractice Verdicts, Settlements & Experts, published by attorney Lewis L. Laska of Nashville, TN. “Malpractice Verdicts”—featuring brief summaries of selected court decisions—debuts this month.

This new column is designed to help CURRENTPSYCHIATRY readers keep up with case law affecting our specialty and the torts of which we might be accused. Then, at least, we might be able to protect ourselves better and worry a little less.

Psychiatrists seem to worry more than other physicians about malpractice claims, even though other specialists face greater numbers of claims and more-astronomical awards. One source of our anxiety is psychiatry’s difficulty in defining “standard of care.”

Twenty years ago, patients with identical symptoms could receive very different treatments, depending on the treating psychiatrists’ philosophies. Our standard of care is better-defined today, but we still may offer a suicidally depressed patient a broader range of treatments than other specialists offer patients with life-threatening illnesses.

We also worry because of the greater “creativity” personal injury lawyers can use in making claims against us, compared with other specialties. For example, most claims against a diagnostic radiologist are limited to failure to diagnose something. Psychiatrists can be subject to claims for not only failing to diagnose or treat mental disorders but also for failing to restrain patients who harm themselves or to protect people we have never met from harm our patients may cause.

To address these concerns, we obtained permission to abstract malpractice cases of interest to psychiatrists from the newsletter Medical Malpractice Verdicts, Settlements & Experts, published by attorney Lewis L. Laska of Nashville, TN. “Malpractice Verdicts”—featuring brief summaries of selected court decisions—debuts this month.

This new column is designed to help CURRENTPSYCHIATRY readers keep up with case law affecting our specialty and the torts of which we might be accused. Then, at least, we might be able to protect ourselves better and worry a little less.

Psychiatrists seem to worry more than other physicians about malpractice claims, even though other specialists face greater numbers of claims and more-astronomical awards. One source of our anxiety is psychiatry’s difficulty in defining “standard of care.”

Twenty years ago, patients with identical symptoms could receive very different treatments, depending on the treating psychiatrists’ philosophies. Our standard of care is better-defined today, but we still may offer a suicidally depressed patient a broader range of treatments than other specialists offer patients with life-threatening illnesses.

We also worry because of the greater “creativity” personal injury lawyers can use in making claims against us, compared with other specialties. For example, most claims against a diagnostic radiologist are limited to failure to diagnose something. Psychiatrists can be subject to claims for not only failing to diagnose or treat mental disorders but also for failing to restrain patients who harm themselves or to protect people we have never met from harm our patients may cause.

To address these concerns, we obtained permission to abstract malpractice cases of interest to psychiatrists from the newsletter Medical Malpractice Verdicts, Settlements & Experts, published by attorney Lewis L. Laska of Nashville, TN. “Malpractice Verdicts”—featuring brief summaries of selected court decisions—debuts this month.

This new column is designed to help CURRENTPSYCHIATRY readers keep up with case law affecting our specialty and the torts of which we might be accused. Then, at least, we might be able to protect ourselves better and worry a little less.

Like you, I always worry about being sued for malpractice. I comfort myself by knowing that not every psychiatrist—or even the majority—has to agree with the way I practice. To meet the “standard of care” and fulfill my duty to patients, my practice just needs to be endorsed by a respectable minority of practitioners.

Two articles in this issue illustrate the legitimate diversity of opinion within psychiatry. Drs. Joseph Pierre, Donna Wirshing, and William Wirshing at UCLA provide an excellent review on higher-than-recommended antipsychotic dosages for patients with treatment-refractory schizophrenia. They conclude that:

• there is very little evidence that high dosages are more effective than usual dosages
• patients who do not respond to usual dosages should be switched to clozapine before high-dose therapy is tried.

We invited Sheldon Preskorn, MD—a Current Psychiatry associate editor—to review the article. Based on his research in clinical psychopharmacology, he wrote a commentary to explain the variables that determine patient response to drug therapy. He suggests that:

• some patients may need higher antipsychotic dosages, which might be tried before switching medications
• plasma levels should be considered before changing treatments.

We’ll let you decide which approach or synthesis of approaches works for you. Whichever you choose will be supported by at least a respectable minority of practitioners.

Like you, I always worry about being sued for malpractice. I comfort myself by knowing that not every psychiatrist—or even the majority—has to agree with the way I practice. To meet the “standard of care” and fulfill my duty to patients, my practice just needs to be endorsed by a respectable minority of practitioners.

Two articles in this issue illustrate the legitimate diversity of opinion within psychiatry. Drs. Joseph Pierre, Donna Wirshing, and William Wirshing at UCLA provide an excellent review on higher-than-recommended antipsychotic dosages for patients with treatment-refractory schizophrenia. They conclude that:

• there is very little evidence that high dosages are more effective than usual dosages
• patients who do not respond to usual dosages should be switched to clozapine before high-dose therapy is tried.

We invited Sheldon Preskorn, MD—a Current Psychiatry associate editor—to review the article. Based on his research in clinical psychopharmacology, he wrote a commentary to explain the variables that determine patient response to drug therapy. He suggests that:

• some patients may need higher antipsychotic dosages, which might be tried before switching medications
• plasma levels should be considered before changing treatments.

We’ll let you decide which approach or synthesis of approaches works for you. Whichever you choose will be supported by at least a respectable minority of practitioners.

Like you, I always worry about being sued for malpractice. I comfort myself by knowing that not every psychiatrist—or even the majority—has to agree with the way I practice. To meet the “standard of care” and fulfill my duty to patients, my practice just needs to be endorsed by a respectable minority of practitioners.

Two articles in this issue illustrate the legitimate diversity of opinion within psychiatry. Drs. Joseph Pierre, Donna Wirshing, and William Wirshing at UCLA provide an excellent review on higher-than-recommended antipsychotic dosages for patients with treatment-refractory schizophrenia. They conclude that:

• there is very little evidence that high dosages are more effective than usual dosages
• patients who do not respond to usual dosages should be switched to clozapine before high-dose therapy is tried.

We invited Sheldon Preskorn, MD—a Current Psychiatry associate editor—to review the article. Based on his research in clinical psychopharmacology, he wrote a commentary to explain the variables that determine patient response to drug therapy. He suggests that:

• some patients may need higher antipsychotic dosages, which might be tried before switching medications
• plasma levels should be considered before changing treatments.

We’ll let you decide which approach or synthesis of approaches works for you. Whichever you choose will be supported by at least a respectable minority of practitioners.

Most of us care for patients with bipolar disorder and face this problem regularly: We start an antidepressant for breakthrough depressive symptoms, and the patient responds. How long do we continue the antidepressant?

In this issue, Robert M. Post, MD, head of the Bipolar Collaborative Network, summarizes the published literature—and some very recent unpublished reports—related to this question and makes systematic recommendations. I won’t attempt to summarize his carefully considered conclusions, but I would like to highlight his two-pronged” approach:

• conservative treatment—no change in medication—when the patient remains well
• aggressive—if not radical—treatment when the illness course remains problematic.

I cannot help but reflect that these recommendations—wise advice for many clinical problems—echo the Hippocratic principles of “first, do no harm” and “extreme illnesses require extreme remedies.” Although, thank goodness, today’s medical treatments bear no resemblance to those used in Hippocrates’ time, our wisdom still bears a resemblance to his.

Conscientious physicians aspire to keep up with the latest literature while growing in professional wisdom. Helping us with those challenging tasks is Current Psychiatry’s goal.

Most of us care for patients with bipolar disorder and face this problem regularly: We start an antidepressant for breakthrough depressive symptoms, and the patient responds. How long do we continue the antidepressant?

In this issue, Robert M. Post, MD, head of the Bipolar Collaborative Network, summarizes the published literature—and some very recent unpublished reports—related to this question and makes systematic recommendations. I won’t attempt to summarize his carefully considered conclusions, but I would like to highlight his two-pronged” approach:

• conservative treatment—no change in medication—when the patient remains well
• aggressive—if not radical—treatment when the illness course remains problematic.

I cannot help but reflect that these recommendations—wise advice for many clinical problems—echo the Hippocratic principles of “first, do no harm” and “extreme illnesses require extreme remedies.” Although, thank goodness, today’s medical treatments bear no resemblance to those used in Hippocrates’ time, our wisdom still bears a resemblance to his.

Conscientious physicians aspire to keep up with the latest literature while growing in professional wisdom. Helping us with those challenging tasks is Current Psychiatry’s goal.

Most of us care for patients with bipolar disorder and face this problem regularly: We start an antidepressant for breakthrough depressive symptoms, and the patient responds. How long do we continue the antidepressant?

In this issue, Robert M. Post, MD, head of the Bipolar Collaborative Network, summarizes the published literature—and some very recent unpublished reports—related to this question and makes systematic recommendations. I won’t attempt to summarize his carefully considered conclusions, but I would like to highlight his two-pronged” approach:

• conservative treatment—no change in medication—when the patient remains well
• aggressive—if not radical—treatment when the illness course remains problematic.

I cannot help but reflect that these recommendations—wise advice for many clinical problems—echo the Hippocratic principles of “first, do no harm” and “extreme illnesses require extreme remedies.” Although, thank goodness, today’s medical treatments bear no resemblance to those used in Hippocrates’ time, our wisdom still bears a resemblance to his.

Conscientious physicians aspire to keep up with the latest literature while growing in professional wisdom. Helping us with those challenging tasks is Current Psychiatry’s goal.

When I started residency, I promised myself I would never pass along to patients the medical and psychiatric advice my parents gave me. Not that my parents gave uniformly bad advice; some of it has helped me—a fact that has taken me decades to admit. The issue was that I wanted to be a scientific practitioner, rather than a purveyor of conventional wisdom.

This stance, of course, has created problems for me. I’m sure much of what my parents told me is true, even though we don’t have much supporting data. So whenever a paper confirms what seems like common knowledge, I feel happy.

That’s why I appreciate the article on exercise and mental health in this month’s issue. It validates what my parents told me and what I have always believed: exercise really does improve psychological well-being. The evidence has been in the literature, but until Sheila M. Dowd, PhD, Kristin S. Vickers, PhD, and Dean Krahn, MD, reviewed it for me, I was not sure I could believe it.

Now, if I can just get myself to start some sort of exercise, I will be really happy.

When I started residency, I promised myself I would never pass along to patients the medical and psychiatric advice my parents gave me. Not that my parents gave uniformly bad advice; some of it has helped me—a fact that has taken me decades to admit. The issue was that I wanted to be a scientific practitioner, rather than a purveyor of conventional wisdom.

This stance, of course, has created problems for me. I’m sure much of what my parents told me is true, even though we don’t have much supporting data. So whenever a paper confirms what seems like common knowledge, I feel happy.

That’s why I appreciate the article on exercise and mental health in this month’s issue. It validates what my parents told me and what I have always believed: exercise really does improve psychological well-being. The evidence has been in the literature, but until Sheila M. Dowd, PhD, Kristin S. Vickers, PhD, and Dean Krahn, MD, reviewed it for me, I was not sure I could believe it.

Now, if I can just get myself to start some sort of exercise, I will be really happy.

When I started residency, I promised myself I would never pass along to patients the medical and psychiatric advice my parents gave me. Not that my parents gave uniformly bad advice; some of it has helped me—a fact that has taken me decades to admit. The issue was that I wanted to be a scientific practitioner, rather than a purveyor of conventional wisdom.

This stance, of course, has created problems for me. I’m sure much of what my parents told me is true, even though we don’t have much supporting data. So whenever a paper confirms what seems like common knowledge, I feel happy.

That’s why I appreciate the article on exercise and mental health in this month’s issue. It validates what my parents told me and what I have always believed: exercise really does improve psychological well-being. The evidence has been in the literature, but until Sheila M. Dowd, PhD, Kristin S. Vickers, PhD, and Dean Krahn, MD, reviewed it for me, I was not sure I could believe it.

Now, if I can just get myself to start some sort of exercise, I will be really happy.

We all know about the Nielsen ratings, which track how many households are watching any given television program. Medical journals have a similar rating system called Focus (produced by Nielsen sister company PERQ/HCI), which tracks how many doctors are reading each journal and how thoroughly they read—cover-to-cover, skim, or not at all.

The reason for the Nielsen and Focus surveys, of course, is advertising revenue. Current Psychiatry—like ABC, CBS, and NBC—is supported almost entirely by advertising, which enables you to receive these TV networks and this medical journal for free.

Twice a year, PERQ/HCI sends Focus surveys to 500 to 600 general psychiatrists, then extrapolates the responses to the universe of 32,797 potential readers. Any of you whom the AMA lists as practicing general psychiatrists—including residents—are in the Focus pool.

Our staff recently received the December 2003 Focus survey tabulations, and I was thrilled. More psychiatrists are reading Current Psychiatry than many other psychiatric journals, including those I assumed were the most widely read. Our readership increased more than 20% in the 6 months since June 2003. And although news tabloids consistently show the highest readership, Current Psychiatry—in only its third year of publication—is being read cover to cover more than any other psychiatric journal.

I interpret these results as validating Current Psychiatry’s founding principle: to publish authoritative information you can use in your practice this week. I welcome your ideas and suggestions (James.Hillard@uc.edu).

We all know about the Nielsen ratings, which track how many households are watching any given television program. Medical journals have a similar rating system called Focus (produced by Nielsen sister company PERQ/HCI), which tracks how many doctors are reading each journal and how thoroughly they read—cover-to-cover, skim, or not at all.

The reason for the Nielsen and Focus surveys, of course, is advertising revenue. Current Psychiatry—like ABC, CBS, and NBC—is supported almost entirely by advertising, which enables you to receive these TV networks and this medical journal for free.

Twice a year, PERQ/HCI sends Focus surveys to 500 to 600 general psychiatrists, then extrapolates the responses to the universe of 32,797 potential readers. Any of you whom the AMA lists as practicing general psychiatrists—including residents—are in the Focus pool.

Our staff recently received the December 2003 Focus survey tabulations, and I was thrilled. More psychiatrists are reading Current Psychiatry than many other psychiatric journals, including those I assumed were the most widely read. Our readership increased more than 20% in the 6 months since June 2003. And although news tabloids consistently show the highest readership, Current Psychiatry—in only its third year of publication—is being read cover to cover more than any other psychiatric journal.

I interpret these results as validating Current Psychiatry’s founding principle: to publish authoritative information you can use in your practice this week. I welcome your ideas and suggestions (James.Hillard@uc.edu).

We all know about the Nielsen ratings, which track how many households are watching any given television program. Medical journals have a similar rating system called Focus (produced by Nielsen sister company PERQ/HCI), which tracks how many doctors are reading each journal and how thoroughly they read—cover-to-cover, skim, or not at all.

The reason for the Nielsen and Focus surveys, of course, is advertising revenue. Current Psychiatry—like ABC, CBS, and NBC—is supported almost entirely by advertising, which enables you to receive these TV networks and this medical journal for free.

Twice a year, PERQ/HCI sends Focus surveys to 500 to 600 general psychiatrists, then extrapolates the responses to the universe of 32,797 potential readers. Any of you whom the AMA lists as practicing general psychiatrists—including residents—are in the Focus pool.

Our staff recently received the December 2003 Focus survey tabulations, and I was thrilled. More psychiatrists are reading Current Psychiatry than many other psychiatric journals, including those I assumed were the most widely read. Our readership increased more than 20% in the 6 months since June 2003. And although news tabloids consistently show the highest readership, Current Psychiatry—in only its third year of publication—is being read cover to cover more than any other psychiatric journal.

I interpret these results as validating Current Psychiatry’s founding principle: to publish authoritative information you can use in your practice this week. I welcome your ideas and suggestions (James.Hillard@uc.edu).

Hypnosis’ decline in psychiatric training programs is surprising, given today’s emphasis on short-term therapies. Hypnosis can be very useful—particularly for patients with anxiety disorders, phobias, and posttraumatic stress disorder—as David Spiegel, MD, of Stanford University writes in his thoughtful scientific review.

My first experience with hypnosis was as a University of North Carolina undergraduate, when a psychology professor did a group hypnotic induction. I scored 7 out of 12 on the Stanford Hypnotic Susceptibility Scale (SHSS), which indicated I was “moderately” hypnotizable. I felt good because the professor said hypnotizable people are curious, brave, and open to new experiences.

Later, as a Stanford University medical student, I was hired as a hypnotist at the Stanford Hypnotic Research Center. My job was to administer a new 5-point SHSS to undergraduates who had been screened with the 12-point version. The shorter version included a 30-minute hypnotic induction—instead of the regular 60 minutes—and was designed for clinical practice.

For 6 months I immediately hypnotized every student, and they all scored at the top of the scale. Naturally, I assumed I was God’s gift to hypnosis. My euphoria ended abruptly, however, when one student scored zero. Rather than going into a trance, he stared at me for a half-hour with pity and mild aggression in his eyes.

From then on, every subject behaved the same way, and none scored more than 1 point. I resigned because I couldn’t take it anymore. Later, I got over my narcissistic wound when I realized I had been involved in a blinded experiment to see how well the shorter scale evaluated students who scored very high or very low on the longer version.

Despite this setback, I have used hypnosis over the years to help treat a variety of psychiatric conditions, with varying degrees of success. I have never, however, regained a belief in my own singularity.

Hypnosis’ decline in psychiatric training programs is surprising, given today’s emphasis on short-term therapies. Hypnosis can be very useful—particularly for patients with anxiety disorders, phobias, and posttraumatic stress disorder—as David Spiegel, MD, of Stanford University writes in his thoughtful scientific review.

My first experience with hypnosis was as a University of North Carolina undergraduate, when a psychology professor did a group hypnotic induction. I scored 7 out of 12 on the Stanford Hypnotic Susceptibility Scale (SHSS), which indicated I was “moderately” hypnotizable. I felt good because the professor said hypnotizable people are curious, brave, and open to new experiences.

Later, as a Stanford University medical student, I was hired as a hypnotist at the Stanford Hypnotic Research Center. My job was to administer a new 5-point SHSS to undergraduates who had been screened with the 12-point version. The shorter version included a 30-minute hypnotic induction—instead of the regular 60 minutes—and was designed for clinical practice.

For 6 months I immediately hypnotized every student, and they all scored at the top of the scale. Naturally, I assumed I was God’s gift to hypnosis. My euphoria ended abruptly, however, when one student scored zero. Rather than going into a trance, he stared at me for a half-hour with pity and mild aggression in his eyes.

From then on, every subject behaved the same way, and none scored more than 1 point. I resigned because I couldn’t take it anymore. Later, I got over my narcissistic wound when I realized I had been involved in a blinded experiment to see how well the shorter scale evaluated students who scored very high or very low on the longer version.

Despite this setback, I have used hypnosis over the years to help treat a variety of psychiatric conditions, with varying degrees of success. I have never, however, regained a belief in my own singularity.

Hypnosis’ decline in psychiatric training programs is surprising, given today’s emphasis on short-term therapies. Hypnosis can be very useful—particularly for patients with anxiety disorders, phobias, and posttraumatic stress disorder—as David Spiegel, MD, of Stanford University writes in his thoughtful scientific review.

My first experience with hypnosis was as a University of North Carolina undergraduate, when a psychology professor did a group hypnotic induction. I scored 7 out of 12 on the Stanford Hypnotic Susceptibility Scale (SHSS), which indicated I was “moderately” hypnotizable. I felt good because the professor said hypnotizable people are curious, brave, and open to new experiences.

Later, as a Stanford University medical student, I was hired as a hypnotist at the Stanford Hypnotic Research Center. My job was to administer a new 5-point SHSS to undergraduates who had been screened with the 12-point version. The shorter version included a 30-minute hypnotic induction—instead of the regular 60 minutes—and was designed for clinical practice.

For 6 months I immediately hypnotized every student, and they all scored at the top of the scale. Naturally, I assumed I was God’s gift to hypnosis. My euphoria ended abruptly, however, when one student scored zero. Rather than going into a trance, he stared at me for a half-hour with pity and mild aggression in his eyes.

From then on, every subject behaved the same way, and none scored more than 1 point. I resigned because I couldn’t take it anymore. Later, I got over my narcissistic wound when I realized I had been involved in a blinded experiment to see how well the shorter scale evaluated students who scored very high or very low on the longer version.

Despite this setback, I have used hypnosis over the years to help treat a variety of psychiatric conditions, with varying degrees of success. I have never, however, regained a belief in my own singularity.

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Before I see them, most of my depressed patients have failed an SSRI trial prescribed by their primary care physicians. Some have already tried two or more antidepressants. I bet your practice is the same.

Unfortunately, few medications have been tested on patients with treatment-resistant depression. To gain FDA approval, an investigational drug needs to show a treatment effect greater than placebo, and testing a drug on a treatment-resistant population is risky for pharmaceutical companies. Compared with monotherapy, even fewer large-scale studies have combined two or more medications for major depressive disorder.

In this issue, A. John Rush, MD, of the University of Texas Southwestern Medical Center, provides the best synthesis I have seen of the literature on treatment-resistant depression. I am already incorporating his insights into my clinical practice.

Not to minimize the suffering of patients with treatment-resistant depression, but I believe this disorder saved psychiatry. Ten years ago, doomsayers predicted psychiatry’s demise, assuming anyone could do psychotherapy and any physician could prescribe 20 mg of Prozac. Those predictions have proven wrong, and demand for psychiatrists has grown.

We do not compete with primary care physicians. The more depressed patients our medical colleagues treat, the more treatment-resistant cases they refer for psychiatric care. We may not be seeing as many patients with nontreatment depression, but fewer with major depressive disorder are suffering without receiving effective treatment.

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Before I see them, most of my depressed patients have failed an SSRI trial prescribed by their primary care physicians. Some have already tried two or more antidepressants. I bet your practice is the same.

Unfortunately, few medications have been tested on patients with treatment-resistant depression. To gain FDA approval, an investigational drug needs to show a treatment effect greater than placebo, and testing a drug on a treatment-resistant population is risky for pharmaceutical companies. Compared with monotherapy, even fewer large-scale studies have combined two or more medications for major depressive disorder.

In this issue, A. John Rush, MD, of the University of Texas Southwestern Medical Center, provides the best synthesis I have seen of the literature on treatment-resistant depression. I am already incorporating his insights into my clinical practice.

Not to minimize the suffering of patients with treatment-resistant depression, but I believe this disorder saved psychiatry. Ten years ago, doomsayers predicted psychiatry’s demise, assuming anyone could do psychotherapy and any physician could prescribe 20 mg of Prozac. Those predictions have proven wrong, and demand for psychiatrists has grown.

We do not compete with primary care physicians. The more depressed patients our medical colleagues treat, the more treatment-resistant cases they refer for psychiatric care. We may not be seeing as many patients with nontreatment depression, but fewer with major depressive disorder are suffering without receiving effective treatment.

f

Before I see them, most of my depressed patients have failed an SSRI trial prescribed by their primary care physicians. Some have already tried two or more antidepressants. I bet your practice is the same.

Unfortunately, few medications have been tested on patients with treatment-resistant depression. To gain FDA approval, an investigational drug needs to show a treatment effect greater than placebo, and testing a drug on a treatment-resistant population is risky for pharmaceutical companies. Compared with monotherapy, even fewer large-scale studies have combined two or more medications for major depressive disorder.

In this issue, A. John Rush, MD, of the University of Texas Southwestern Medical Center, provides the best synthesis I have seen of the literature on treatment-resistant depression. I am already incorporating his insights into my clinical practice.

Not to minimize the suffering of patients with treatment-resistant depression, but I believe this disorder saved psychiatry. Ten years ago, doomsayers predicted psychiatry’s demise, assuming anyone could do psychotherapy and any physician could prescribe 20 mg of Prozac. Those predictions have proven wrong, and demand for psychiatrists has grown.

We do not compete with primary care physicians. The more depressed patients our medical colleagues treat, the more treatment-resistant cases they refer for psychiatric care. We may not be seeing as many patients with nontreatment depression, but fewer with major depressive disorder are suffering without receiving effective treatment.