James Randolph Hillard, MD

Sometimes I envy pediatricians and geriatricians. Although they face challenges caring for infants or demented elders who can’t describe their aches and pains, these physicians need to know about and treat only one age group. As general psychiatrists, we must diagnose and treat every mental disorder from cradle to grave.

To help you accomplish that task, this month’s Current Psychiatry covers the age spectrum from early childhood to late life with articles on autism, adolescent depression, schizophrenia, sexual addiction, and late-life psychosis. I’ve recently treated every problem covered in this issue—with the exception of autism—and I suspect you have, too. And although I have not treated autistic patients lately, I often am asked questions and prefer to answer knowledgably about the status of diagnosis and treatment of that difficult condition.

From the autism article by David Posey, MD, and Christopher McDougle, MD, I learned that autism and other pervasive developmental disabilities are more common than was previously believed. I had thought maybe I was just hearing about them more frequently. I also understand for the first time the diagnostic points that distinguish autism from Rett’s and childhood disintegrative disorders.

The article on adolescent depression by Ann Wagner, PhD, and Benedetto Vitiello, MD, of the National Institute of Mental Health reminded me of the similarities and differences between adult and adolescent mood disorders. I knew that depression in teens can be persistent, but I had not realized that as many as one-third of depressed teens require second-step approaches or combination therapy. It’s good to know that the NIMH is funding studies of SSRI antidepressants plus cognitive-behavioral therapy for adolescents with major depression.

The article on the diagnosis of sexual addiction by Steven Mahorney, MD, was a revelation. Prior to reading the article, my understanding was closer to the mainstream view, as set forth by Neal Dunsieth Jr., MD, in his commentary. I realize I may have been missing this diagnosis because I was not looking for it, and I did not have a good idea of how to treat it. Now, I can conceptualize sexual addiction in useful behavioral and psychological terms.

From the article on late-life psychosis by Renee Snow, MD, and Sumer Verma, MD, I learned that 13% of patients are diagnosed with new-onset schizophrenia after age 50 and 7% after age 60. I also learned that one-half of all patients with vascular or mixed dementias have psychotic symptoms. These numbers are much higher than I had imagined, but fortunately the article’s update on diagnosis and treatment helped me prepare to see more of these patients.

So, as usual, Current Psychiatry has helped me with the daunting task of keeping up with the diseases and treatments of our patients throughout the life span.

Speaking of developmental life stages, this infant—Current Psychiatry—is now 6 months old. It is sitting up and drinking from a cup and everything (not bad for a 6-month-old, eh?). Send me an email (hillarjr@email.uc.edu) if there are other milestones you would like our publication to attain.

Sometimes I envy pediatricians and geriatricians. Although they face challenges caring for infants or demented elders who can’t describe their aches and pains, these physicians need to know about and treat only one age group. As general psychiatrists, we must diagnose and treat every mental disorder from cradle to grave.

To help you accomplish that task, this month’s Current Psychiatry covers the age spectrum from early childhood to late life with articles on autism, adolescent depression, schizophrenia, sexual addiction, and late-life psychosis. I’ve recently treated every problem covered in this issue—with the exception of autism—and I suspect you have, too. And although I have not treated autistic patients lately, I often am asked questions and prefer to answer knowledgably about the status of diagnosis and treatment of that difficult condition.

From the autism article by David Posey, MD, and Christopher McDougle, MD, I learned that autism and other pervasive developmental disabilities are more common than was previously believed. I had thought maybe I was just hearing about them more frequently. I also understand for the first time the diagnostic points that distinguish autism from Rett’s and childhood disintegrative disorders.

The article on adolescent depression by Ann Wagner, PhD, and Benedetto Vitiello, MD, of the National Institute of Mental Health reminded me of the similarities and differences between adult and adolescent mood disorders. I knew that depression in teens can be persistent, but I had not realized that as many as one-third of depressed teens require second-step approaches or combination therapy. It’s good to know that the NIMH is funding studies of SSRI antidepressants plus cognitive-behavioral therapy for adolescents with major depression.

The article on the diagnosis of sexual addiction by Steven Mahorney, MD, was a revelation. Prior to reading the article, my understanding was closer to the mainstream view, as set forth by Neal Dunsieth Jr., MD, in his commentary. I realize I may have been missing this diagnosis because I was not looking for it, and I did not have a good idea of how to treat it. Now, I can conceptualize sexual addiction in useful behavioral and psychological terms.

From the article on late-life psychosis by Renee Snow, MD, and Sumer Verma, MD, I learned that 13% of patients are diagnosed with new-onset schizophrenia after age 50 and 7% after age 60. I also learned that one-half of all patients with vascular or mixed dementias have psychotic symptoms. These numbers are much higher than I had imagined, but fortunately the article’s update on diagnosis and treatment helped me prepare to see more of these patients.

So, as usual, Current Psychiatry has helped me with the daunting task of keeping up with the diseases and treatments of our patients throughout the life span.

Speaking of developmental life stages, this infant—Current Psychiatry—is now 6 months old. It is sitting up and drinking from a cup and everything (not bad for a 6-month-old, eh?). Send me an email (hillarjr@email.uc.edu) if there are other milestones you would like our publication to attain.

Sometimes I envy pediatricians and geriatricians. Although they face challenges caring for infants or demented elders who can’t describe their aches and pains, these physicians need to know about and treat only one age group. As general psychiatrists, we must diagnose and treat every mental disorder from cradle to grave.

To help you accomplish that task, this month’s Current Psychiatry covers the age spectrum from early childhood to late life with articles on autism, adolescent depression, schizophrenia, sexual addiction, and late-life psychosis. I’ve recently treated every problem covered in this issue—with the exception of autism—and I suspect you have, too. And although I have not treated autistic patients lately, I often am asked questions and prefer to answer knowledgably about the status of diagnosis and treatment of that difficult condition.

From the autism article by David Posey, MD, and Christopher McDougle, MD, I learned that autism and other pervasive developmental disabilities are more common than was previously believed. I had thought maybe I was just hearing about them more frequently. I also understand for the first time the diagnostic points that distinguish autism from Rett’s and childhood disintegrative disorders.

The article on adolescent depression by Ann Wagner, PhD, and Benedetto Vitiello, MD, of the National Institute of Mental Health reminded me of the similarities and differences between adult and adolescent mood disorders. I knew that depression in teens can be persistent, but I had not realized that as many as one-third of depressed teens require second-step approaches or combination therapy. It’s good to know that the NIMH is funding studies of SSRI antidepressants plus cognitive-behavioral therapy for adolescents with major depression.

The article on the diagnosis of sexual addiction by Steven Mahorney, MD, was a revelation. Prior to reading the article, my understanding was closer to the mainstream view, as set forth by Neal Dunsieth Jr., MD, in his commentary. I realize I may have been missing this diagnosis because I was not looking for it, and I did not have a good idea of how to treat it. Now, I can conceptualize sexual addiction in useful behavioral and psychological terms.

From the article on late-life psychosis by Renee Snow, MD, and Sumer Verma, MD, I learned that 13% of patients are diagnosed with new-onset schizophrenia after age 50 and 7% after age 60. I also learned that one-half of all patients with vascular or mixed dementias have psychotic symptoms. These numbers are much higher than I had imagined, but fortunately the article’s update on diagnosis and treatment helped me prepare to see more of these patients.

So, as usual, Current Psychiatry has helped me with the daunting task of keeping up with the diseases and treatments of our patients throughout the life span.

Speaking of developmental life stages, this infant—Current Psychiatry—is now 6 months old. It is sitting up and drinking from a cup and everything (not bad for a 6-month-old, eh?). Send me an email (hillarjr@email.uc.edu) if there are other milestones you would like our publication to attain.

Sometimes I envy pediatricians and geriatricians. Although they face challenges caring for infants or demented elders who can’t describe their aches and pains, these physicians need to know about and treat only one age group. As general psychiatrists, we must diagnose and treat every mental disorder from cradle to grave.

To help you accomplish that task, this month’s Current Psychiatry covers the age spectrum from early childhood to late life with articles on autism, adolescent depression, schizophrenia, sexual addiction, and late-life psychosis. I’ve recently treated every problem covered in this issue—with the exception of autism—and I suspect you have, too. And although I have not treated autistic patients lately, I often am asked questions and prefer to answer knowledgably about the status of diagnosis and treatment of that difficult condition.

From the autism article by David Posey, MD, and Christopher McDougle, MD, I learned that autism and other pervasive developmental disabilities are more common than was previously believed. I had thought maybe I was just hearing about them more frequently. I also understand for the first time the diagnostic points that distinguish autism from Rett’s and childhood disintegrative disorders.

The article on adolescent depression by Ann Wagner, PhD, and Benedetto Vitiello, MD, of the National Institute of Mental Health reminded me of the similarities and differences between adult and adolescent mood disorders. I knew that depression in teens can be persistent, but I had not realized that as many as one-third of depressed teens require second-step approaches or combination therapy. It’s good to know that the NIMH is funding studies of SSRI antidepressants plus cognitive-behavioral therapy for adolescents with major depression.

The article on the diagnosis of sexual addiction by Steven Mahorney, MD, was a revelation. Prior to reading the article, my understanding was closer to the mainstream view, as set forth by Neal Dunsieth Jr., MD, in his commentary. I realize I may have been missing this diagnosis because I was not looking for it, and I did not have a good idea of how to treat it. Now, I can conceptualize sexual addiction in useful behavioral and psychological terms.

From the article on late-life psychosis by Renee Snow, MD, and Sumer Verma, MD, I learned that 13% of patients are diagnosed with new-onset schizophrenia after age 50 and 7% after age 60. I also learned that one-half of all patients with vascular or mixed dementias have psychotic symptoms. These numbers are much higher than I had imagined, but fortunately the article’s update on diagnosis and treatment helped me prepare to see more of these patients.

So, as usual, Current Psychiatry has helped me with the daunting task of keeping up with the diseases and treatments of our patients throughout the life span.

Speaking of developmental life stages, this infant—Current Psychiatry—is now 6 months old. It is sitting up and drinking from a cup and everything (not bad for a 6-month-old, eh?). Send me an email (hillarjr@email.uc.edu) if there are other milestones you would like our publication to attain.

Sometimes I envy pediatricians and geriatricians. Although they face challenges caring for infants or demented elders who can’t describe their aches and pains, these physicians need to know about and treat only one age group. As general psychiatrists, we must diagnose and treat every mental disorder from cradle to grave.

To help you accomplish that task, this month’s Current Psychiatry covers the age spectrum from early childhood to late life with articles on autism, adolescent depression, schizophrenia, sexual addiction, and late-life psychosis. I’ve recently treated every problem covered in this issue—with the exception of autism—and I suspect you have, too. And although I have not treated autistic patients lately, I often am asked questions and prefer to answer knowledgably about the status of diagnosis and treatment of that difficult condition.

From the autism article by David Posey, MD, and Christopher McDougle, MD, I learned that autism and other pervasive developmental disabilities are more common than was previously believed. I had thought maybe I was just hearing about them more frequently. I also understand for the first time the diagnostic points that distinguish autism from Rett’s and childhood disintegrative disorders.

The article on adolescent depression by Ann Wagner, PhD, and Benedetto Vitiello, MD, of the National Institute of Mental Health reminded me of the similarities and differences between adult and adolescent mood disorders. I knew that depression in teens can be persistent, but I had not realized that as many as one-third of depressed teens require second-step approaches or combination therapy. It’s good to know that the NIMH is funding studies of SSRI antidepressants plus cognitive-behavioral therapy for adolescents with major depression.

The article on the diagnosis of sexual addiction by Steven Mahorney, MD, was a revelation. Prior to reading the article, my understanding was closer to the mainstream view, as set forth by Neal Dunsieth Jr., MD, in his commentary. I realize I may have been missing this diagnosis because I was not looking for it, and I did not have a good idea of how to treat it. Now, I can conceptualize sexual addiction in useful behavioral and psychological terms.

From the article on late-life psychosis by Renee Snow, MD, and Sumer Verma, MD, I learned that 13% of patients are diagnosed with new-onset schizophrenia after age 50 and 7% after age 60. I also learned that one-half of all patients with vascular or mixed dementias have psychotic symptoms. These numbers are much higher than I had imagined, but fortunately the article’s update on diagnosis and treatment helped me prepare to see more of these patients.

So, as usual, Current Psychiatry has helped me with the daunting task of keeping up with the diseases and treatments of our patients throughout the life span.

Speaking of developmental life stages, this infant—Current Psychiatry—is now 6 months old. It is sitting up and drinking from a cup and everything (not bad for a 6-month-old, eh?). Send me an email (hillarjr@email.uc.edu) if there are other milestones you would like our publication to attain.

Sometimes I envy pediatricians and geriatricians. Although they face challenges caring for infants or demented elders who can’t describe their aches and pains, these physicians need to know about and treat only one age group. As general psychiatrists, we must diagnose and treat every mental disorder from cradle to grave.

To help you accomplish that task, this month’s Current Psychiatry covers the age spectrum from early childhood to late life with articles on autism, adolescent depression, schizophrenia, sexual addiction, and late-life psychosis. I’ve recently treated every problem covered in this issue—with the exception of autism—and I suspect you have, too. And although I have not treated autistic patients lately, I often am asked questions and prefer to answer knowledgably about the status of diagnosis and treatment of that difficult condition.

From the autism article by David Posey, MD, and Christopher McDougle, MD, I learned that autism and other pervasive developmental disabilities are more common than was previously believed. I had thought maybe I was just hearing about them more frequently. I also understand for the first time the diagnostic points that distinguish autism from Rett’s and childhood disintegrative disorders.

The article on adolescent depression by Ann Wagner, PhD, and Benedetto Vitiello, MD, of the National Institute of Mental Health reminded me of the similarities and differences between adult and adolescent mood disorders. I knew that depression in teens can be persistent, but I had not realized that as many as one-third of depressed teens require second-step approaches or combination therapy. It’s good to know that the NIMH is funding studies of SSRI antidepressants plus cognitive-behavioral therapy for adolescents with major depression.

The article on the diagnosis of sexual addiction by Steven Mahorney, MD, was a revelation. Prior to reading the article, my understanding was closer to the mainstream view, as set forth by Neal Dunsieth Jr., MD, in his commentary. I realize I may have been missing this diagnosis because I was not looking for it, and I did not have a good idea of how to treat it. Now, I can conceptualize sexual addiction in useful behavioral and psychological terms.

From the article on late-life psychosis by Renee Snow, MD, and Sumer Verma, MD, I learned that 13% of patients are diagnosed with new-onset schizophrenia after age 50 and 7% after age 60. I also learned that one-half of all patients with vascular or mixed dementias have psychotic symptoms. These numbers are much higher than I had imagined, but fortunately the article’s update on diagnosis and treatment helped me prepare to see more of these patients.

So, as usual, Current Psychiatry has helped me with the daunting task of keeping up with the diseases and treatments of our patients throughout the life span.

Speaking of developmental life stages, this infant—Current Psychiatry—is now 6 months old. It is sitting up and drinking from a cup and everything (not bad for a 6-month-old, eh?). Send me an email (hillarjr@email.uc.edu) if there are other milestones you would like our publication to attain.

Lately I have become more alert to the warning signs of aging—my own aging, that is. For example, I realize that I am old enough to remember at least three previous “rediscoveries” of MAO inhibitors.

MAOIs were discovered before tricyclic antidepressants but were largely displaced from clinical practice by TCAs by the end of the 1950s. MAOIs were first rediscovered in the 1960s as a treatment for “atypical depression,” characterized by too much rather than too little sleep and appetite. Soon afterward, however, these agents went into eclipse again. In the 1970s and 1980s, they were rediscovered as a treatment for mild (but not severe) depression and maybe for subsyndromal depressive symptoms. In the 1990s, selective and reversible MAOIs gave rise to another rediscovery.

Jonathan Cole, MD (who is significantly older than I am) and J. Alexander Bodkin, MD, have contributed an outstanding review of MAOIs for this month’s issue. Their review reassures me that psychopharmacology is progressing steadily, although it has seemed pretty confusing all the while. I had more or less given up using MAOIs before reading this article, but now I am going to start prescribing them again—at least occasionally.

Also in this issue, John Zajecka, MD, and Rajendra Tummala, MD, address the role of TCAs in modern psychiatric practice. I must admit that I kept using tricyclics after selective serotonin reuptake inhibitors and similar agents became the predominant therapeutic modality. I saw no reason to switch patients who had been doing well on TCAs for years without intolerable side effects. I am happy that this article gives me a rationale for continuing to use them—at least occasionally.

Fibromyalgia is a condition that—like the MAOIs—has been discovered, faded into obscurity, and been rediscovered numerous times since it was first described in 1904 and declared an epidemic in the 1990s. Lately, many patients I have seen with this chronic problem have shown up with reams of printouts from the Internet about fibromyalgia and frequently also about irritable bowel syndrome, interstitial cystitis, chronic fatigue syndrome, and migraine headache. The insightful discussion of the CNS connection in fibromyalgia by Lesley Arnold, MD, has helped me catch up with my patients.

The article “Substance abuse: 12 principles to more effective outpatient treatment” by Drs. Robert Forman, Charles Dackis, and Richard Rawson is one of the wisest papers I have read recently because it integrates new perspectives with a wealth of clinical experience. And thanks to Loren Friedman’s review of medications in the pipeline for Alzheimer’s disease, I now know about treatments that are likely to reach the market soon.

It is hard to keep up with everything new in psychiatry and even harder to retain everything old at the same time. But integrating the new with the old is how we develop wisdom, isn’t it? If so, I think this month’s issue of Current Psychiatry will make us all a bit wiser.

As always, I value your reaction to the articles in this month’s issue and your suggestions for future topics. Write to Current Psychiatry, Quadrant HealthCom Inc., 110 Summit Ave., Montvale, NJ 07645, or email me at hillarjr@email.uc.edu.

Lately I have become more alert to the warning signs of aging—my own aging, that is. For example, I realize that I am old enough to remember at least three previous “rediscoveries” of MAO inhibitors.

MAOIs were discovered before tricyclic antidepressants but were largely displaced from clinical practice by TCAs by the end of the 1950s. MAOIs were first rediscovered in the 1960s as a treatment for “atypical depression,” characterized by too much rather than too little sleep and appetite. Soon afterward, however, these agents went into eclipse again. In the 1970s and 1980s, they were rediscovered as a treatment for mild (but not severe) depression and maybe for subsyndromal depressive symptoms. In the 1990s, selective and reversible MAOIs gave rise to another rediscovery.

Jonathan Cole, MD (who is significantly older than I am) and J. Alexander Bodkin, MD, have contributed an outstanding review of MAOIs for this month’s issue. Their review reassures me that psychopharmacology is progressing steadily, although it has seemed pretty confusing all the while. I had more or less given up using MAOIs before reading this article, but now I am going to start prescribing them again—at least occasionally.

Also in this issue, John Zajecka, MD, and Rajendra Tummala, MD, address the role of TCAs in modern psychiatric practice. I must admit that I kept using tricyclics after selective serotonin reuptake inhibitors and similar agents became the predominant therapeutic modality. I saw no reason to switch patients who had been doing well on TCAs for years without intolerable side effects. I am happy that this article gives me a rationale for continuing to use them—at least occasionally.

Fibromyalgia is a condition that—like the MAOIs—has been discovered, faded into obscurity, and been rediscovered numerous times since it was first described in 1904 and declared an epidemic in the 1990s. Lately, many patients I have seen with this chronic problem have shown up with reams of printouts from the Internet about fibromyalgia and frequently also about irritable bowel syndrome, interstitial cystitis, chronic fatigue syndrome, and migraine headache. The insightful discussion of the CNS connection in fibromyalgia by Lesley Arnold, MD, has helped me catch up with my patients.

The article “Substance abuse: 12 principles to more effective outpatient treatment” by Drs. Robert Forman, Charles Dackis, and Richard Rawson is one of the wisest papers I have read recently because it integrates new perspectives with a wealth of clinical experience. And thanks to Loren Friedman’s review of medications in the pipeline for Alzheimer’s disease, I now know about treatments that are likely to reach the market soon.

It is hard to keep up with everything new in psychiatry and even harder to retain everything old at the same time. But integrating the new with the old is how we develop wisdom, isn’t it? If so, I think this month’s issue of Current Psychiatry will make us all a bit wiser.

As always, I value your reaction to the articles in this month’s issue and your suggestions for future topics. Write to Current Psychiatry, Quadrant HealthCom Inc., 110 Summit Ave., Montvale, NJ 07645, or email me at hillarjr@email.uc.edu.

Lately I have become more alert to the warning signs of aging—my own aging, that is. For example, I realize that I am old enough to remember at least three previous “rediscoveries” of MAO inhibitors.

MAOIs were discovered before tricyclic antidepressants but were largely displaced from clinical practice by TCAs by the end of the 1950s. MAOIs were first rediscovered in the 1960s as a treatment for “atypical depression,” characterized by too much rather than too little sleep and appetite. Soon afterward, however, these agents went into eclipse again. In the 1970s and 1980s, they were rediscovered as a treatment for mild (but not severe) depression and maybe for subsyndromal depressive symptoms. In the 1990s, selective and reversible MAOIs gave rise to another rediscovery.

Jonathan Cole, MD (who is significantly older than I am) and J. Alexander Bodkin, MD, have contributed an outstanding review of MAOIs for this month’s issue. Their review reassures me that psychopharmacology is progressing steadily, although it has seemed pretty confusing all the while. I had more or less given up using MAOIs before reading this article, but now I am going to start prescribing them again—at least occasionally.

Also in this issue, John Zajecka, MD, and Rajendra Tummala, MD, address the role of TCAs in modern psychiatric practice. I must admit that I kept using tricyclics after selective serotonin reuptake inhibitors and similar agents became the predominant therapeutic modality. I saw no reason to switch patients who had been doing well on TCAs for years without intolerable side effects. I am happy that this article gives me a rationale for continuing to use them—at least occasionally.

Fibromyalgia is a condition that—like the MAOIs—has been discovered, faded into obscurity, and been rediscovered numerous times since it was first described in 1904 and declared an epidemic in the 1990s. Lately, many patients I have seen with this chronic problem have shown up with reams of printouts from the Internet about fibromyalgia and frequently also about irritable bowel syndrome, interstitial cystitis, chronic fatigue syndrome, and migraine headache. The insightful discussion of the CNS connection in fibromyalgia by Lesley Arnold, MD, has helped me catch up with my patients.

The article “Substance abuse: 12 principles to more effective outpatient treatment” by Drs. Robert Forman, Charles Dackis, and Richard Rawson is one of the wisest papers I have read recently because it integrates new perspectives with a wealth of clinical experience. And thanks to Loren Friedman’s review of medications in the pipeline for Alzheimer’s disease, I now know about treatments that are likely to reach the market soon.

It is hard to keep up with everything new in psychiatry and even harder to retain everything old at the same time. But integrating the new with the old is how we develop wisdom, isn’t it? If so, I think this month’s issue of Current Psychiatry will make us all a bit wiser.

As always, I value your reaction to the articles in this month’s issue and your suggestions for future topics. Write to Current Psychiatry, Quadrant HealthCom Inc., 110 Summit Ave., Montvale, NJ 07645, or email me at hillarjr@email.uc.edu.

This month’s Current Psychiatry highlights patient violence and aggression—a topic that gives psychiatry and its patients a bad name. Most psychiatric patients are never violent, and psychiatric patients are no more likely than anyone else to commit a violent crime. When patients do become violent, however, they can create a lot of fear for—and pose a real danger to—family and fellow patients, as well as us practitioners.

Most of us do not confront violent patients often, but knowing how to handle an acutely agitated patient is at least as important to psychiatrists as is knowing how to perform CPR. Dr. Avrim Fishkind’s article on psychosocial approaches to managing aggressive behavior should be required reading for everyone in training, and it would be useful for a practicing psychiatrist to read at least once a year. I hope that my article on pharmacologic treatment of aggressive behavior is worth reading at least once.

Violence induced by a psychiatric disorder is not only an issue in the psychiatric practice or emergency room, but in society as well. John Kennedy, MD, MHA, Drew Barzman, MD, and Manish Fozdar, MD, drive this point home as they effectively summarize the evidence on traumatic brain injury and violence an association that I’ve never been quite clear on before.

Although not directly about violence, the article “Bipolar update: How to better predict response to maintenance therapy” fits in nicely. Several years ago, when I surveyed staff injuries at the University Hospital in Cincinnati, I found that acutely manic patients were more likely than were patients with other psychiatric disorders to assault staff. This finding surprised me; I thought that acutely intoxicated or acutely schizophrenic patients might be more prone to violent episodes. My interpretation of this finding is that the unpredictability of bipolar patients causes us to let our guard down and increases our vulnerability to aggressive patient behavior.

That said, appropriate bipolar maintenance therapy should decrease the likelihood of assaults on staff, as well as increase the patient’s quality of life.

In the other feature this month, Gerald Maguire, MD, and others review new treatments for patients who stutter. This article is a nice change of pace and makes me optimistic about treating a condition that, for a long time, I regarded as more or less untreatable.

This month’s issue reminds me of the problem I have in shaping medical students’ attitudes toward psychiatry. Students still do their clinical clerkships mostly on the inpatient service, where lengths of stay are very short and patients generally have to be dangerous to be admitted. My job is to convince the students that in psychiatry we can stay safe, help people, and enjoy ourselves in the process. I wish that I could get every medical student in the country to read this month’s issue of Current Psychiatry!

This month’s Current Psychiatry highlights patient violence and aggression—a topic that gives psychiatry and its patients a bad name. Most psychiatric patients are never violent, and psychiatric patients are no more likely than anyone else to commit a violent crime. When patients do become violent, however, they can create a lot of fear for—and pose a real danger to—family and fellow patients, as well as us practitioners.

Most of us do not confront violent patients often, but knowing how to handle an acutely agitated patient is at least as important to psychiatrists as is knowing how to perform CPR. Dr. Avrim Fishkind’s article on psychosocial approaches to managing aggressive behavior should be required reading for everyone in training, and it would be useful for a practicing psychiatrist to read at least once a year. I hope that my article on pharmacologic treatment of aggressive behavior is worth reading at least once.

Violence induced by a psychiatric disorder is not only an issue in the psychiatric practice or emergency room, but in society as well. John Kennedy, MD, MHA, Drew Barzman, MD, and Manish Fozdar, MD, drive this point home as they effectively summarize the evidence on traumatic brain injury and violence an association that I’ve never been quite clear on before.

Although not directly about violence, the article “Bipolar update: How to better predict response to maintenance therapy” fits in nicely. Several years ago, when I surveyed staff injuries at the University Hospital in Cincinnati, I found that acutely manic patients were more likely than were patients with other psychiatric disorders to assault staff. This finding surprised me; I thought that acutely intoxicated or acutely schizophrenic patients might be more prone to violent episodes. My interpretation of this finding is that the unpredictability of bipolar patients causes us to let our guard down and increases our vulnerability to aggressive patient behavior.

That said, appropriate bipolar maintenance therapy should decrease the likelihood of assaults on staff, as well as increase the patient’s quality of life.

In the other feature this month, Gerald Maguire, MD, and others review new treatments for patients who stutter. This article is a nice change of pace and makes me optimistic about treating a condition that, for a long time, I regarded as more or less untreatable.

This month’s issue reminds me of the problem I have in shaping medical students’ attitudes toward psychiatry. Students still do their clinical clerkships mostly on the inpatient service, where lengths of stay are very short and patients generally have to be dangerous to be admitted. My job is to convince the students that in psychiatry we can stay safe, help people, and enjoy ourselves in the process. I wish that I could get every medical student in the country to read this month’s issue of Current Psychiatry!

This month’s Current Psychiatry highlights patient violence and aggression—a topic that gives psychiatry and its patients a bad name. Most psychiatric patients are never violent, and psychiatric patients are no more likely than anyone else to commit a violent crime. When patients do become violent, however, they can create a lot of fear for—and pose a real danger to—family and fellow patients, as well as us practitioners.

Most of us do not confront violent patients often, but knowing how to handle an acutely agitated patient is at least as important to psychiatrists as is knowing how to perform CPR. Dr. Avrim Fishkind’s article on psychosocial approaches to managing aggressive behavior should be required reading for everyone in training, and it would be useful for a practicing psychiatrist to read at least once a year. I hope that my article on pharmacologic treatment of aggressive behavior is worth reading at least once.

Violence induced by a psychiatric disorder is not only an issue in the psychiatric practice or emergency room, but in society as well. John Kennedy, MD, MHA, Drew Barzman, MD, and Manish Fozdar, MD, drive this point home as they effectively summarize the evidence on traumatic brain injury and violence an association that I’ve never been quite clear on before.

Although not directly about violence, the article “Bipolar update: How to better predict response to maintenance therapy” fits in nicely. Several years ago, when I surveyed staff injuries at the University Hospital in Cincinnati, I found that acutely manic patients were more likely than were patients with other psychiatric disorders to assault staff. This finding surprised me; I thought that acutely intoxicated or acutely schizophrenic patients might be more prone to violent episodes. My interpretation of this finding is that the unpredictability of bipolar patients causes us to let our guard down and increases our vulnerability to aggressive patient behavior.

That said, appropriate bipolar maintenance therapy should decrease the likelihood of assaults on staff, as well as increase the patient’s quality of life.

In the other feature this month, Gerald Maguire, MD, and others review new treatments for patients who stutter. This article is a nice change of pace and makes me optimistic about treating a condition that, for a long time, I regarded as more or less untreatable.

This month’s issue reminds me of the problem I have in shaping medical students’ attitudes toward psychiatry. Students still do their clinical clerkships mostly on the inpatient service, where lengths of stay are very short and patients generally have to be dangerous to be admitted. My job is to convince the students that in psychiatry we can stay safe, help people, and enjoy ourselves in the process. I wish that I could get every medical student in the country to read this month’s issue of Current Psychiatry!

This month’s Current Psychiatry highlights patient violence and aggression—a topic that gives psychiatry and its patients a bad name. Most psychiatric patients are never violent, and psychiatric patients are no more likely than anyone else to commit a violent crime. When patients do become violent, however, they can create a lot of fear for—and pose a real danger to—family and fellow patients, as well as us practitioners.

Most of us do not confront violent patients often, but knowing how to handle an acutely agitated patient is at least as important to psychiatrists as is knowing how to perform CPR. Dr. Avrim Fishkind’s article on psychosocial approaches to managing aggressive behavior should be required reading for everyone in training, and it would be useful for a practicing psychiatrist to read at least once a year. I hope that my article on pharmacologic treatment of aggressive behavior is worth reading at least once.

Violence induced by a psychiatric disorder is not only an issue in the psychiatric practice or emergency room, but in society as well. John Kennedy, MD, MHA, Drew Barzman, MD, and Manish Fozdar, MD, drive this point home as they effectively summarize the evidence on traumatic brain injury and violence an association that I’ve never been quite clear on before.

Although not directly about violence, the article “Bipolar update: How to better predict response to maintenance therapy” fits in nicely. Several years ago, when I surveyed staff injuries at the University Hospital in Cincinnati, I found that acutely manic patients were more likely than were patients with other psychiatric disorders to assault staff. This finding surprised me; I thought that acutely intoxicated or acutely schizophrenic patients might be more prone to violent episodes. My interpretation of this finding is that the unpredictability of bipolar patients causes us to let our guard down and increases our vulnerability to aggressive patient behavior.

That said, appropriate bipolar maintenance therapy should decrease the likelihood of assaults on staff, as well as increase the patient’s quality of life.

In the other feature this month, Gerald Maguire, MD, and others review new treatments for patients who stutter. This article is a nice change of pace and makes me optimistic about treating a condition that, for a long time, I regarded as more or less untreatable.

This month’s issue reminds me of the problem I have in shaping medical students’ attitudes toward psychiatry. Students still do their clinical clerkships mostly on the inpatient service, where lengths of stay are very short and patients generally have to be dangerous to be admitted. My job is to convince the students that in psychiatry we can stay safe, help people, and enjoy ourselves in the process. I wish that I could get every medical student in the country to read this month’s issue of Current Psychiatry!

This month’s Current Psychiatry highlights patient violence and aggression—a topic that gives psychiatry and its patients a bad name. Most psychiatric patients are never violent, and psychiatric patients are no more likely than anyone else to commit a violent crime. When patients do become violent, however, they can create a lot of fear for—and pose a real danger to—family and fellow patients, as well as us practitioners.

Most of us do not confront violent patients often, but knowing how to handle an acutely agitated patient is at least as important to psychiatrists as is knowing how to perform CPR. Dr. Avrim Fishkind’s article on psychosocial approaches to managing aggressive behavior should be required reading for everyone in training, and it would be useful for a practicing psychiatrist to read at least once a year. I hope that my article on pharmacologic treatment of aggressive behavior is worth reading at least once.

Violence induced by a psychiatric disorder is not only an issue in the psychiatric practice or emergency room, but in society as well. John Kennedy, MD, MHA, Drew Barzman, MD, and Manish Fozdar, MD, drive this point home as they effectively summarize the evidence on traumatic brain injury and violence an association that I’ve never been quite clear on before.

Although not directly about violence, the article “Bipolar update: How to better predict response to maintenance therapy” fits in nicely. Several years ago, when I surveyed staff injuries at the University Hospital in Cincinnati, I found that acutely manic patients were more likely than were patients with other psychiatric disorders to assault staff. This finding surprised me; I thought that acutely intoxicated or acutely schizophrenic patients might be more prone to violent episodes. My interpretation of this finding is that the unpredictability of bipolar patients causes us to let our guard down and increases our vulnerability to aggressive patient behavior.

That said, appropriate bipolar maintenance therapy should decrease the likelihood of assaults on staff, as well as increase the patient’s quality of life.

In the other feature this month, Gerald Maguire, MD, and others review new treatments for patients who stutter. This article is a nice change of pace and makes me optimistic about treating a condition that, for a long time, I regarded as more or less untreatable.

This month’s issue reminds me of the problem I have in shaping medical students’ attitudes toward psychiatry. Students still do their clinical clerkships mostly on the inpatient service, where lengths of stay are very short and patients generally have to be dangerous to be admitted. My job is to convince the students that in psychiatry we can stay safe, help people, and enjoy ourselves in the process. I wish that I could get every medical student in the country to read this month’s issue of Current Psychiatry!

This month’s Current Psychiatry highlights patient violence and aggression—a topic that gives psychiatry and its patients a bad name. Most psychiatric patients are never violent, and psychiatric patients are no more likely than anyone else to commit a violent crime. When patients do become violent, however, they can create a lot of fear for—and pose a real danger to—family and fellow patients, as well as us practitioners.

Most of us do not confront violent patients often, but knowing how to handle an acutely agitated patient is at least as important to psychiatrists as is knowing how to perform CPR. Dr. Avrim Fishkind’s article on psychosocial approaches to managing aggressive behavior should be required reading for everyone in training, and it would be useful for a practicing psychiatrist to read at least once a year. I hope that my article on pharmacologic treatment of aggressive behavior is worth reading at least once.

Violence induced by a psychiatric disorder is not only an issue in the psychiatric practice or emergency room, but in society as well. John Kennedy, MD, MHA, Drew Barzman, MD, and Manish Fozdar, MD, drive this point home as they effectively summarize the evidence on traumatic brain injury and violence an association that I’ve never been quite clear on before.

Although not directly about violence, the article “Bipolar update: How to better predict response to maintenance therapy” fits in nicely. Several years ago, when I surveyed staff injuries at the University Hospital in Cincinnati, I found that acutely manic patients were more likely than were patients with other psychiatric disorders to assault staff. This finding surprised me; I thought that acutely intoxicated or acutely schizophrenic patients might be more prone to violent episodes. My interpretation of this finding is that the unpredictability of bipolar patients causes us to let our guard down and increases our vulnerability to aggressive patient behavior.

That said, appropriate bipolar maintenance therapy should decrease the likelihood of assaults on staff, as well as increase the patient’s quality of life.

In the other feature this month, Gerald Maguire, MD, and others review new treatments for patients who stutter. This article is a nice change of pace and makes me optimistic about treating a condition that, for a long time, I regarded as more or less untreatable.

This month’s issue reminds me of the problem I have in shaping medical students’ attitudes toward psychiatry. Students still do their clinical clerkships mostly on the inpatient service, where lengths of stay are very short and patients generally have to be dangerous to be admitted. My job is to convince the students that in psychiatry we can stay safe, help people, and enjoy ourselves in the process. I wish that I could get every medical student in the country to read this month’s issue of Current Psychiatry!

The title above is a direct quote from my teenage son after I had finished a somewhat overlong description of the obesity research going on in my department. I can’t remember what I said at the time—something about obesity relating to the intersection of biology and behavior, and that is what psychiatry is about. On the other hand, since I was caught off guard, I probably said something really stupid like, “It’s psychiatry because we are doing it in our offices.”

Which disorders are “psychiatric” and which are not? It really is a non-trivial question. In this issue, we have an article on rapid-cycling bipolar disorder, which everybody would agree is a psychiatric condition. On the other hand, I think that others may wonder why we chose the other topics included in this issue:

• Obesity? Bariatric medicine, whatever that is.
• Hypothermia? Internal medicine.
• Dementia? Neurology.
• Shyness? Not a disorder at all.
• Stalking? A matter for the police.

Of course, I do not agree with those who might assign these disorders to other disciplines or I would not have chosen to have articles on them in the journal. But why are these psychiatric topics? All of them do represent an intersection of biology and behavior, and all cause a lot of pain for those who suffer from them.

As our knowledge of neurobiology and behavior have expanded, so have the boundaries of psychiatry to include topics such as shyness, once thought to be purely “psychological,” and dementia, once perceived as “biological.” Hypothermia can complicate our treatment of various mental disorders. Shyness causes an enormous range of symptoms. On its more severe end, shyness probably combines a biological predisposition with a vicious cycle of symptoms leading to stress, which in turn leads to worse symptoms. Effective treatment of obesity must be something more than instructions to “just eat less and exercise more.” Stalking is a dilemma that, like it or not, can just walk into our offices.

Which brings me back to what I am afraid I actually said to my son: “It’s psychiatry because we are doing it in our offices.” I guess you could call it an operational definition. Anyway, what psychiatrists are actually doing in their offices is precisely what Current Psychiatry is about.

The title above is a direct quote from my teenage son after I had finished a somewhat overlong description of the obesity research going on in my department. I can’t remember what I said at the time—something about obesity relating to the intersection of biology and behavior, and that is what psychiatry is about. On the other hand, since I was caught off guard, I probably said something really stupid like, “It’s psychiatry because we are doing it in our offices.”

Which disorders are “psychiatric” and which are not? It really is a non-trivial question. In this issue, we have an article on rapid-cycling bipolar disorder, which everybody would agree is a psychiatric condition. On the other hand, I think that others may wonder why we chose the other topics included in this issue:

• Obesity? Bariatric medicine, whatever that is.
• Hypothermia? Internal medicine.
• Dementia? Neurology.
• Shyness? Not a disorder at all.
• Stalking? A matter for the police.

Of course, I do not agree with those who might assign these disorders to other disciplines or I would not have chosen to have articles on them in the journal. But why are these psychiatric topics? All of them do represent an intersection of biology and behavior, and all cause a lot of pain for those who suffer from them.

As our knowledge of neurobiology and behavior have expanded, so have the boundaries of psychiatry to include topics such as shyness, once thought to be purely “psychological,” and dementia, once perceived as “biological.” Hypothermia can complicate our treatment of various mental disorders. Shyness causes an enormous range of symptoms. On its more severe end, shyness probably combines a biological predisposition with a vicious cycle of symptoms leading to stress, which in turn leads to worse symptoms. Effective treatment of obesity must be something more than instructions to “just eat less and exercise more.” Stalking is a dilemma that, like it or not, can just walk into our offices.

Which brings me back to what I am afraid I actually said to my son: “It’s psychiatry because we are doing it in our offices.” I guess you could call it an operational definition. Anyway, what psychiatrists are actually doing in their offices is precisely what Current Psychiatry is about.

The title above is a direct quote from my teenage son after I had finished a somewhat overlong description of the obesity research going on in my department. I can’t remember what I said at the time—something about obesity relating to the intersection of biology and behavior, and that is what psychiatry is about. On the other hand, since I was caught off guard, I probably said something really stupid like, “It’s psychiatry because we are doing it in our offices.”

Which disorders are “psychiatric” and which are not? It really is a non-trivial question. In this issue, we have an article on rapid-cycling bipolar disorder, which everybody would agree is a psychiatric condition. On the other hand, I think that others may wonder why we chose the other topics included in this issue:

• Obesity? Bariatric medicine, whatever that is.
• Hypothermia? Internal medicine.
• Dementia? Neurology.
• Shyness? Not a disorder at all.
• Stalking? A matter for the police.

Of course, I do not agree with those who might assign these disorders to other disciplines or I would not have chosen to have articles on them in the journal. But why are these psychiatric topics? All of them do represent an intersection of biology and behavior, and all cause a lot of pain for those who suffer from them.

As our knowledge of neurobiology and behavior have expanded, so have the boundaries of psychiatry to include topics such as shyness, once thought to be purely “psychological,” and dementia, once perceived as “biological.” Hypothermia can complicate our treatment of various mental disorders. Shyness causes an enormous range of symptoms. On its more severe end, shyness probably combines a biological predisposition with a vicious cycle of symptoms leading to stress, which in turn leads to worse symptoms. Effective treatment of obesity must be something more than instructions to “just eat less and exercise more.” Stalking is a dilemma that, like it or not, can just walk into our offices.

Which brings me back to what I am afraid I actually said to my son: “It’s psychiatry because we are doing it in our offices.” I guess you could call it an operational definition. Anyway, what psychiatrists are actually doing in their offices is precisely what Current Psychiatry is about.

The title above is a direct quote from my teenage son after I had finished a somewhat overlong description of the obesity research going on in my department. I can’t remember what I said at the time—something about obesity relating to the intersection of biology and behavior, and that is what psychiatry is about. On the other hand, since I was caught off guard, I probably said something really stupid like, “It’s psychiatry because we are doing it in our offices.”

Which disorders are “psychiatric” and which are not? It really is a non-trivial question. In this issue, we have an article on rapid-cycling bipolar disorder, which everybody would agree is a psychiatric condition. On the other hand, I think that others may wonder why we chose the other topics included in this issue:

• Obesity? Bariatric medicine, whatever that is.
• Hypothermia? Internal medicine.
• Dementia? Neurology.
• Shyness? Not a disorder at all.
• Stalking? A matter for the police.

Of course, I do not agree with those who might assign these disorders to other disciplines or I would not have chosen to have articles on them in the journal. But why are these psychiatric topics? All of them do represent an intersection of biology and behavior, and all cause a lot of pain for those who suffer from them.

As our knowledge of neurobiology and behavior have expanded, so have the boundaries of psychiatry to include topics such as shyness, once thought to be purely “psychological,” and dementia, once perceived as “biological.” Hypothermia can complicate our treatment of various mental disorders. Shyness causes an enormous range of symptoms. On its more severe end, shyness probably combines a biological predisposition with a vicious cycle of symptoms leading to stress, which in turn leads to worse symptoms. Effective treatment of obesity must be something more than instructions to “just eat less and exercise more.” Stalking is a dilemma that, like it or not, can just walk into our offices.

Which brings me back to what I am afraid I actually said to my son: “It’s psychiatry because we are doing it in our offices.” I guess you could call it an operational definition. Anyway, what psychiatrists are actually doing in their offices is precisely what Current Psychiatry is about.

The title above is a direct quote from my teenage son after I had finished a somewhat overlong description of the obesity research going on in my department. I can’t remember what I said at the time—something about obesity relating to the intersection of biology and behavior, and that is what psychiatry is about. On the other hand, since I was caught off guard, I probably said something really stupid like, “It’s psychiatry because we are doing it in our offices.”

Which disorders are “psychiatric” and which are not? It really is a non-trivial question. In this issue, we have an article on rapid-cycling bipolar disorder, which everybody would agree is a psychiatric condition. On the other hand, I think that others may wonder why we chose the other topics included in this issue:

• Obesity? Bariatric medicine, whatever that is.
• Hypothermia? Internal medicine.
• Dementia? Neurology.
• Shyness? Not a disorder at all.
• Stalking? A matter for the police.

Of course, I do not agree with those who might assign these disorders to other disciplines or I would not have chosen to have articles on them in the journal. But why are these psychiatric topics? All of them do represent an intersection of biology and behavior, and all cause a lot of pain for those who suffer from them.

As our knowledge of neurobiology and behavior have expanded, so have the boundaries of psychiatry to include topics such as shyness, once thought to be purely “psychological,” and dementia, once perceived as “biological.” Hypothermia can complicate our treatment of various mental disorders. Shyness causes an enormous range of symptoms. On its more severe end, shyness probably combines a biological predisposition with a vicious cycle of symptoms leading to stress, which in turn leads to worse symptoms. Effective treatment of obesity must be something more than instructions to “just eat less and exercise more.” Stalking is a dilemma that, like it or not, can just walk into our offices.

Which brings me back to what I am afraid I actually said to my son: “It’s psychiatry because we are doing it in our offices.” I guess you could call it an operational definition. Anyway, what psychiatrists are actually doing in their offices is precisely what Current Psychiatry is about.

The title above is a direct quote from my teenage son after I had finished a somewhat overlong description of the obesity research going on in my department. I can’t remember what I said at the time—something about obesity relating to the intersection of biology and behavior, and that is what psychiatry is about. On the other hand, since I was caught off guard, I probably said something really stupid like, “It’s psychiatry because we are doing it in our offices.”

Which disorders are “psychiatric” and which are not? It really is a non-trivial question. In this issue, we have an article on rapid-cycling bipolar disorder, which everybody would agree is a psychiatric condition. On the other hand, I think that others may wonder why we chose the other topics included in this issue:

• Obesity? Bariatric medicine, whatever that is.
• Hypothermia? Internal medicine.
• Dementia? Neurology.
• Shyness? Not a disorder at all.
• Stalking? A matter for the police.

Of course, I do not agree with those who might assign these disorders to other disciplines or I would not have chosen to have articles on them in the journal. But why are these psychiatric topics? All of them do represent an intersection of biology and behavior, and all cause a lot of pain for those who suffer from them.

As our knowledge of neurobiology and behavior have expanded, so have the boundaries of psychiatry to include topics such as shyness, once thought to be purely “psychological,” and dementia, once perceived as “biological.” Hypothermia can complicate our treatment of various mental disorders. Shyness causes an enormous range of symptoms. On its more severe end, shyness probably combines a biological predisposition with a vicious cycle of symptoms leading to stress, which in turn leads to worse symptoms. Effective treatment of obesity must be something more than instructions to “just eat less and exercise more.” Stalking is a dilemma that, like it or not, can just walk into our offices.

Which brings me back to what I am afraid I actually said to my son: “It’s psychiatry because we are doing it in our offices.” I guess you could call it an operational definition. Anyway, what psychiatrists are actually doing in their offices is precisely what Current Psychiatry is about.

Here it is, our second issue of Current Psychiatry, and I am already asking for your help. Sort of reminds me of when my medical school asked me for alumni donations before I even became an alumnus.

Fortunately, I am not asking for money like my medical school does. Current Psychiatry is, and will continue to be, a free service to the profession. Everyone who is listed on the AMA database as a general psychiatrist should be receiving this publication. If you are seeing someone else’s copy and believe you should be on the mailing list, send your name, address, type of practice, and e-mail address to: Three weeks to mood stabilization,” by William P. Carter, MD. I enjoyed reading this case because it mirrors the cases I actually treat. Dr. Carter’s patient account does not represent a “pure” case with a single clear-cut diagnosis, nor is there a surprise ending showing what a superhuman clinician the author is. Nor does the patient suffer from an extremely rare disorder.

It is a case, though, that left me with a lot of good ideas. For example, I have never been clear on the best approaches for dealing with noncompliance due to sexual side effects or for addressing weight gain associated with psychotropic medications. This case, while acknowledging that there is no one “right” way to treat these problems, sets out several possible rational approaches, several of which I would not have thought of on my own.

The reality of clinical practice, of course, is that patients keep coming in with complaints that we need to treat, even if we have to try approaches not yet totally validated experimentally.

Anyway, back to asking for help. I would like you, our readers, to share your cases with us. I want this journal to be relevant to psychiatry as it is really practiced. (In fact, I originally wanted to call this journal “Real Psychiatry,” but the marketing department overruled me.) So if you have ideas for cases, please e-mail Dr. Carter at wpcarter@partners.org.

Even if you do not have a case you feel is worth sharing, you can still help me by

1. Suggesting topics you would like to see reviewed in Current Psychiatry and, if you wish, doctors who you think should review them;
2. Writing an article yourself.

If you have a topic you are interested in, please send me an e-mail, and I will let you know if the topic fits our editorial guidelines or if we already have something similar under development.

Here are some specific topics that have been suggested, for which I am seeking authors:

• Psychotropics in the management of chronic pain
• Schizoaffective disorder: Is it real?
• Negative symptoms of schizophrenia
• Avoiding adverse reactions in patients taking Viagra
• Use of SSRIs in treating panic disorder
• Treating substance abuse in the presence of comorbid conditions
• Depression in patients with anxiety disorders
• Recognizing and treating histrionic personality disorder.

I can be reached at hillarjr@email.uc.edu.

Finally, please let me know what you think of each issue. Let me know what you would like to see more of—or less of. Putting together a journal like this is like practicing medicine—I always have to keep learning from those I serve, or else I will not be able to help them very much.

Here it is, our second issue of Current Psychiatry, and I am already asking for your help. Sort of reminds me of when my medical school asked me for alumni donations before I even became an alumnus.

Fortunately, I am not asking for money like my medical school does. Current Psychiatry is, and will continue to be, a free service to the profession. Everyone who is listed on the AMA database as a general psychiatrist should be receiving this publication. If you are seeing someone else’s copy and believe you should be on the mailing list, send your name, address, type of practice, and e-mail address to: Three weeks to mood stabilization,” by William P. Carter, MD. I enjoyed reading this case because it mirrors the cases I actually treat. Dr. Carter’s patient account does not represent a “pure” case with a single clear-cut diagnosis, nor is there a surprise ending showing what a superhuman clinician the author is. Nor does the patient suffer from an extremely rare disorder.

It is a case, though, that left me with a lot of good ideas. For example, I have never been clear on the best approaches for dealing with noncompliance due to sexual side effects or for addressing weight gain associated with psychotropic medications. This case, while acknowledging that there is no one “right” way to treat these problems, sets out several possible rational approaches, several of which I would not have thought of on my own.

The reality of clinical practice, of course, is that patients keep coming in with complaints that we need to treat, even if we have to try approaches not yet totally validated experimentally.

Anyway, back to asking for help. I would like you, our readers, to share your cases with us. I want this journal to be relevant to psychiatry as it is really practiced. (In fact, I originally wanted to call this journal “Real Psychiatry,” but the marketing department overruled me.) So if you have ideas for cases, please e-mail Dr. Carter at wpcarter@partners.org.

Even if you do not have a case you feel is worth sharing, you can still help me by

1. Suggesting topics you would like to see reviewed in Current Psychiatry and, if you wish, doctors who you think should review them;
2. Writing an article yourself.

If you have a topic you are interested in, please send me an e-mail, and I will let you know if the topic fits our editorial guidelines or if we already have something similar under development.

Here are some specific topics that have been suggested, for which I am seeking authors:

• Psychotropics in the management of chronic pain
• Schizoaffective disorder: Is it real?
• Negative symptoms of schizophrenia
• Avoiding adverse reactions in patients taking Viagra
• Use of SSRIs in treating panic disorder
• Treating substance abuse in the presence of comorbid conditions
• Depression in patients with anxiety disorders
• Recognizing and treating histrionic personality disorder.

I can be reached at hillarjr@email.uc.edu.

Finally, please let me know what you think of each issue. Let me know what you would like to see more of—or less of. Putting together a journal like this is like practicing medicine—I always have to keep learning from those I serve, or else I will not be able to help them very much.

Here it is, our second issue of Current Psychiatry, and I am already asking for your help. Sort of reminds me of when my medical school asked me for alumni donations before I even became an alumnus.

Fortunately, I am not asking for money like my medical school does. Current Psychiatry is, and will continue to be, a free service to the profession. Everyone who is listed on the AMA database as a general psychiatrist should be receiving this publication. If you are seeing someone else’s copy and believe you should be on the mailing list, send your name, address, type of practice, and e-mail address to: Three weeks to mood stabilization,” by William P. Carter, MD. I enjoyed reading this case because it mirrors the cases I actually treat. Dr. Carter’s patient account does not represent a “pure” case with a single clear-cut diagnosis, nor is there a surprise ending showing what a superhuman clinician the author is. Nor does the patient suffer from an extremely rare disorder.

It is a case, though, that left me with a lot of good ideas. For example, I have never been clear on the best approaches for dealing with noncompliance due to sexual side effects or for addressing weight gain associated with psychotropic medications. This case, while acknowledging that there is no one “right” way to treat these problems, sets out several possible rational approaches, several of which I would not have thought of on my own.

The reality of clinical practice, of course, is that patients keep coming in with complaints that we need to treat, even if we have to try approaches not yet totally validated experimentally.

Anyway, back to asking for help. I would like you, our readers, to share your cases with us. I want this journal to be relevant to psychiatry as it is really practiced. (In fact, I originally wanted to call this journal “Real Psychiatry,” but the marketing department overruled me.) So if you have ideas for cases, please e-mail Dr. Carter at wpcarter@partners.org.

Even if you do not have a case you feel is worth sharing, you can still help me by

1. Suggesting topics you would like to see reviewed in Current Psychiatry and, if you wish, doctors who you think should review them;
2. Writing an article yourself.

If you have a topic you are interested in, please send me an e-mail, and I will let you know if the topic fits our editorial guidelines or if we already have something similar under development.

Here are some specific topics that have been suggested, for which I am seeking authors:

• Psychotropics in the management of chronic pain
• Schizoaffective disorder: Is it real?
• Negative symptoms of schizophrenia
• Avoiding adverse reactions in patients taking Viagra
• Use of SSRIs in treating panic disorder
• Treating substance abuse in the presence of comorbid conditions
• Depression in patients with anxiety disorders
• Recognizing and treating histrionic personality disorder.

I can be reached at hillarjr@email.uc.edu.

Finally, please let me know what you think of each issue. Let me know what you would like to see more of—or less of. Putting together a journal like this is like practicing medicine—I always have to keep learning from those I serve, or else I will not be able to help them very much.

Here it is, our second issue of Current Psychiatry, and I am already asking for your help. Sort of reminds me of when my medical school asked me for alumni donations before I even became an alumnus.

Fortunately, I am not asking for money like my medical school does. Current Psychiatry is, and will continue to be, a free service to the profession. Everyone who is listed on the AMA database as a general psychiatrist should be receiving this publication. If you are seeing someone else’s copy and believe you should be on the mailing list, send your name, address, type of practice, and e-mail address to: Three weeks to mood stabilization,” by William P. Carter, MD. I enjoyed reading this case because it mirrors the cases I actually treat. Dr. Carter’s patient account does not represent a “pure” case with a single clear-cut diagnosis, nor is there a surprise ending showing what a superhuman clinician the author is. Nor does the patient suffer from an extremely rare disorder.

It is a case, though, that left me with a lot of good ideas. For example, I have never been clear on the best approaches for dealing with noncompliance due to sexual side effects or for addressing weight gain associated with psychotropic medications. This case, while acknowledging that there is no one “right” way to treat these problems, sets out several possible rational approaches, several of which I would not have thought of on my own.

The reality of clinical practice, of course, is that patients keep coming in with complaints that we need to treat, even if we have to try approaches not yet totally validated experimentally.

Anyway, back to asking for help. I would like you, our readers, to share your cases with us. I want this journal to be relevant to psychiatry as it is really practiced. (In fact, I originally wanted to call this journal “Real Psychiatry,” but the marketing department overruled me.) So if you have ideas for cases, please e-mail Dr. Carter at wpcarter@partners.org.

Even if you do not have a case you feel is worth sharing, you can still help me by

1. Suggesting topics you would like to see reviewed in Current Psychiatry and, if you wish, doctors who you think should review them;
2. Writing an article yourself.

If you have a topic you are interested in, please send me an e-mail, and I will let you know if the topic fits our editorial guidelines or if we already have something similar under development.

Here are some specific topics that have been suggested, for which I am seeking authors:

• Psychotropics in the management of chronic pain
• Schizoaffective disorder: Is it real?
• Negative symptoms of schizophrenia
• Avoiding adverse reactions in patients taking Viagra
• Use of SSRIs in treating panic disorder
• Treating substance abuse in the presence of comorbid conditions
• Depression in patients with anxiety disorders
• Recognizing and treating histrionic personality disorder.

I can be reached at hillarjr@email.uc.edu.

Finally, please let me know what you think of each issue. Let me know what you would like to see more of—or less of. Putting together a journal like this is like practicing medicine—I always have to keep learning from those I serve, or else I will not be able to help them very much.

Here it is, our second issue of Current Psychiatry, and I am already asking for your help. Sort of reminds me of when my medical school asked me for alumni donations before I even became an alumnus.

Fortunately, I am not asking for money like my medical school does. Current Psychiatry is, and will continue to be, a free service to the profession. Everyone who is listed on the AMA database as a general psychiatrist should be receiving this publication. If you are seeing someone else’s copy and believe you should be on the mailing list, send your name, address, type of practice, and e-mail address to: Three weeks to mood stabilization,” by William P. Carter, MD. I enjoyed reading this case because it mirrors the cases I actually treat. Dr. Carter’s patient account does not represent a “pure” case with a single clear-cut diagnosis, nor is there a surprise ending showing what a superhuman clinician the author is. Nor does the patient suffer from an extremely rare disorder.

It is a case, though, that left me with a lot of good ideas. For example, I have never been clear on the best approaches for dealing with noncompliance due to sexual side effects or for addressing weight gain associated with psychotropic medications. This case, while acknowledging that there is no one “right” way to treat these problems, sets out several possible rational approaches, several of which I would not have thought of on my own.

The reality of clinical practice, of course, is that patients keep coming in with complaints that we need to treat, even if we have to try approaches not yet totally validated experimentally.

Anyway, back to asking for help. I would like you, our readers, to share your cases with us. I want this journal to be relevant to psychiatry as it is really practiced. (In fact, I originally wanted to call this journal “Real Psychiatry,” but the marketing department overruled me.) So if you have ideas for cases, please e-mail Dr. Carter at wpcarter@partners.org.

Even if you do not have a case you feel is worth sharing, you can still help me by

1. Suggesting topics you would like to see reviewed in Current Psychiatry and, if you wish, doctors who you think should review them;
2. Writing an article yourself.

If you have a topic you are interested in, please send me an e-mail, and I will let you know if the topic fits our editorial guidelines or if we already have something similar under development.

Here are some specific topics that have been suggested, for which I am seeking authors:

• Psychotropics in the management of chronic pain
• Schizoaffective disorder: Is it real?
• Negative symptoms of schizophrenia
• Avoiding adverse reactions in patients taking Viagra
• Use of SSRIs in treating panic disorder
• Treating substance abuse in the presence of comorbid conditions
• Depression in patients with anxiety disorders
• Recognizing and treating histrionic personality disorder.

I can be reached at hillarjr@email.uc.edu.

Finally, please let me know what you think of each issue. Let me know what you would like to see more of—or less of. Putting together a journal like this is like practicing medicine—I always have to keep learning from those I serve, or else I will not be able to help them very much.

Here it is, our second issue of Current Psychiatry, and I am already asking for your help. Sort of reminds me of when my medical school asked me for alumni donations before I even became an alumnus.

Fortunately, I am not asking for money like my medical school does. Current Psychiatry is, and will continue to be, a free service to the profession. Everyone who is listed on the AMA database as a general psychiatrist should be receiving this publication. If you are seeing someone else’s copy and believe you should be on the mailing list, send your name, address, type of practice, and e-mail address to: Three weeks to mood stabilization,” by William P. Carter, MD. I enjoyed reading this case because it mirrors the cases I actually treat. Dr. Carter’s patient account does not represent a “pure” case with a single clear-cut diagnosis, nor is there a surprise ending showing what a superhuman clinician the author is. Nor does the patient suffer from an extremely rare disorder.

It is a case, though, that left me with a lot of good ideas. For example, I have never been clear on the best approaches for dealing with noncompliance due to sexual side effects or for addressing weight gain associated with psychotropic medications. This case, while acknowledging that there is no one “right” way to treat these problems, sets out several possible rational approaches, several of which I would not have thought of on my own.

The reality of clinical practice, of course, is that patients keep coming in with complaints that we need to treat, even if we have to try approaches not yet totally validated experimentally.

Anyway, back to asking for help. I would like you, our readers, to share your cases with us. I want this journal to be relevant to psychiatry as it is really practiced. (In fact, I originally wanted to call this journal “Real Psychiatry,” but the marketing department overruled me.) So if you have ideas for cases, please e-mail Dr. Carter at wpcarter@partners.org.

Even if you do not have a case you feel is worth sharing, you can still help me by

1. Suggesting topics you would like to see reviewed in Current Psychiatry and, if you wish, doctors who you think should review them;
2. Writing an article yourself.

If you have a topic you are interested in, please send me an e-mail, and I will let you know if the topic fits our editorial guidelines or if we already have something similar under development.

Here are some specific topics that have been suggested, for which I am seeking authors:

• Psychotropics in the management of chronic pain
• Schizoaffective disorder: Is it real?
• Negative symptoms of schizophrenia
• Avoiding adverse reactions in patients taking Viagra
• Use of SSRIs in treating panic disorder
• Treating substance abuse in the presence of comorbid conditions
• Depression in patients with anxiety disorders
• Recognizing and treating histrionic personality disorder.

I can be reached at hillarjr@email.uc.edu.

Finally, please let me know what you think of each issue. Let me know what you would like to see more of—or less of. Putting together a journal like this is like practicing medicine—I always have to keep learning from those I serve, or else I will not be able to help them very much.

It was not that long ago, at least not in geological time, that I finished my psychiatry residency. Most of what I learned has turned out to be wrong, however, and I am pretty sure that a lot of what I have learned since then will turn out to be wrong too. That is just how science is—it never stands still.

Now, for the most part, it is a good thing that what I learned in the 1970s has turned out to be wrong. The psychopharmacology we had available then was not really that great, although we did the best we could with it. The only kind of psychotherapy we learned was fairly lengthy (24 sessions = short term) psychodynamic therapy. Some of my attendings were still using psychoanalysis to treat peptic ulcer disease, rheumatoid arthritis, and stuttering.

Yes, psychiatry has seen many changes for the better over the years. The profession also has seen numerous changes in practice (e.g., managed care and ever more creative theories of professional liability) that are not positive. Like it or not, we need to deal with the bad changes as well as the good.

The real difficulty about all this change is that it is so incredibly hard to keep up. My old school certainly does not send me correction notices every time something I learned there becomes outdated, although they do send me regular requests for donations. The pharmaceutical companies do send me ongoing updates on what is new, although you really have to worry a little about whether their information is always 100% balanced (don’t get me wrong, some of my best friends are drug reps, but still…). Research journals generally leave me feeling more inadequate, rather than less. They usually presuppose some knowledge I do not have, and their articles usually do not tie directly to clinical practice.

So here I am, feeling increasingly anxious because I cannot keep up with the latest evidence on a new treatment for the patients I work with. You probably feel at least a little of this same anxiety. What is the best treatment for this condition? This or that new psychopharmacologic agent? Psychotherapy? Maybe so, but probably not.

The real treatment for us is a journal that publishes succinct review articles by experts who are still in touch with the realities of clinical practice; a journal of new information you can use; a journal that is up to date, readable, and concise. That journal is Current Psychiatry.

Reading the contents of this first issue in manuscript form has made me feel a lot more confident that I can use new diagnostic and treatment concepts about which I was previously a little fuzzy. For the first time, I really understand which of the anticonvulsants may help my bipolar patients. Frankly, I have always been a little concerned about anticonvulsants because I have tended to regard them as belonging to the neurologists rather than to us.

I also feel better about how to treat my diabetic patients. I am finally convinced that body dysmorphic disorder is real, not just something somebody made up. I feel less out of date in recognizing social phobias and in detecting causes of excessive daytime sleepiness. In my practice I have already started using what I have learned in this issue!

Let Current Psychiatry work for you too. This is your journal. We will survey you to find out what you are interested in. We will ask you to share your cases. We want your input on everything—including this first issue. In addition to review articles addressing psychiatric issues, we will offer updates on commonly confronted medical problems, case discussions, and information on psychotropics under development that even your drug rep cannot tell you about.

If you have a comment on this inaugural issue of Current Psychiatry, or there is anything else you want to see, just drop me a line at hillarjr@email.uc.edu. Together we will keep our practices up to date with minimal pain and maximal gain and we will be able month by month to help our patients more and more.

It was not that long ago, at least not in geological time, that I finished my psychiatry residency. Most of what I learned has turned out to be wrong, however, and I am pretty sure that a lot of what I have learned since then will turn out to be wrong too. That is just how science is—it never stands still.

Now, for the most part, it is a good thing that what I learned in the 1970s has turned out to be wrong. The psychopharmacology we had available then was not really that great, although we did the best we could with it. The only kind of psychotherapy we learned was fairly lengthy (24 sessions = short term) psychodynamic therapy. Some of my attendings were still using psychoanalysis to treat peptic ulcer disease, rheumatoid arthritis, and stuttering.

Yes, psychiatry has seen many changes for the better over the years. The profession also has seen numerous changes in practice (e.g., managed care and ever more creative theories of professional liability) that are not positive. Like it or not, we need to deal with the bad changes as well as the good.

The real difficulty about all this change is that it is so incredibly hard to keep up. My old school certainly does not send me correction notices every time something I learned there becomes outdated, although they do send me regular requests for donations. The pharmaceutical companies do send me ongoing updates on what is new, although you really have to worry a little about whether their information is always 100% balanced (don’t get me wrong, some of my best friends are drug reps, but still…). Research journals generally leave me feeling more inadequate, rather than less. They usually presuppose some knowledge I do not have, and their articles usually do not tie directly to clinical practice.

So here I am, feeling increasingly anxious because I cannot keep up with the latest evidence on a new treatment for the patients I work with. You probably feel at least a little of this same anxiety. What is the best treatment for this condition? This or that new psychopharmacologic agent? Psychotherapy? Maybe so, but probably not.

The real treatment for us is a journal that publishes succinct review articles by experts who are still in touch with the realities of clinical practice; a journal of new information you can use; a journal that is up to date, readable, and concise. That journal is Current Psychiatry.

Reading the contents of this first issue in manuscript form has made me feel a lot more confident that I can use new diagnostic and treatment concepts about which I was previously a little fuzzy. For the first time, I really understand which of the anticonvulsants may help my bipolar patients. Frankly, I have always been a little concerned about anticonvulsants because I have tended to regard them as belonging to the neurologists rather than to us.

I also feel better about how to treat my diabetic patients. I am finally convinced that body dysmorphic disorder is real, not just something somebody made up. I feel less out of date in recognizing social phobias and in detecting causes of excessive daytime sleepiness. In my practice I have already started using what I have learned in this issue!

Let Current Psychiatry work for you too. This is your journal. We will survey you to find out what you are interested in. We will ask you to share your cases. We want your input on everything—including this first issue. In addition to review articles addressing psychiatric issues, we will offer updates on commonly confronted medical problems, case discussions, and information on psychotropics under development that even your drug rep cannot tell you about.

If you have a comment on this inaugural issue of Current Psychiatry, or there is anything else you want to see, just drop me a line at hillarjr@email.uc.edu. Together we will keep our practices up to date with minimal pain and maximal gain and we will be able month by month to help our patients more and more.

It was not that long ago, at least not in geological time, that I finished my psychiatry residency. Most of what I learned has turned out to be wrong, however, and I am pretty sure that a lot of what I have learned since then will turn out to be wrong too. That is just how science is—it never stands still.

Now, for the most part, it is a good thing that what I learned in the 1970s has turned out to be wrong. The psychopharmacology we had available then was not really that great, although we did the best we could with it. The only kind of psychotherapy we learned was fairly lengthy (24 sessions = short term) psychodynamic therapy. Some of my attendings were still using psychoanalysis to treat peptic ulcer disease, rheumatoid arthritis, and stuttering.

Yes, psychiatry has seen many changes for the better over the years. The profession also has seen numerous changes in practice (e.g., managed care and ever more creative theories of professional liability) that are not positive. Like it or not, we need to deal with the bad changes as well as the good.

The real difficulty about all this change is that it is so incredibly hard to keep up. My old school certainly does not send me correction notices every time something I learned there becomes outdated, although they do send me regular requests for donations. The pharmaceutical companies do send me ongoing updates on what is new, although you really have to worry a little about whether their information is always 100% balanced (don’t get me wrong, some of my best friends are drug reps, but still…). Research journals generally leave me feeling more inadequate, rather than less. They usually presuppose some knowledge I do not have, and their articles usually do not tie directly to clinical practice.

So here I am, feeling increasingly anxious because I cannot keep up with the latest evidence on a new treatment for the patients I work with. You probably feel at least a little of this same anxiety. What is the best treatment for this condition? This or that new psychopharmacologic agent? Psychotherapy? Maybe so, but probably not.

The real treatment for us is a journal that publishes succinct review articles by experts who are still in touch with the realities of clinical practice; a journal of new information you can use; a journal that is up to date, readable, and concise. That journal is Current Psychiatry.

Reading the contents of this first issue in manuscript form has made me feel a lot more confident that I can use new diagnostic and treatment concepts about which I was previously a little fuzzy. For the first time, I really understand which of the anticonvulsants may help my bipolar patients. Frankly, I have always been a little concerned about anticonvulsants because I have tended to regard them as belonging to the neurologists rather than to us.

I also feel better about how to treat my diabetic patients. I am finally convinced that body dysmorphic disorder is real, not just something somebody made up. I feel less out of date in recognizing social phobias and in detecting causes of excessive daytime sleepiness. In my practice I have already started using what I have learned in this issue!

Let Current Psychiatry work for you too. This is your journal. We will survey you to find out what you are interested in. We will ask you to share your cases. We want your input on everything—including this first issue. In addition to review articles addressing psychiatric issues, we will offer updates on commonly confronted medical problems, case discussions, and information on psychotropics under development that even your drug rep cannot tell you about.

If you have a comment on this inaugural issue of Current Psychiatry, or there is anything else you want to see, just drop me a line at hillarjr@email.uc.edu. Together we will keep our practices up to date with minimal pain and maximal gain and we will be able month by month to help our patients more and more.