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Neuroimaging
The application of neuroimaging technology in psychiatric research has revolutionized clinical neuroscience perspectives on the pathophysiology of the major psychiatric disorders. Research using a variety of types of neuroimaging techniques has shown that these conditions are associated with abnormalities of brain function, structure and receptor pharmacology. These data also corroborate the conclusions reached from genetic, endocrine, and clinical pharmacology research involving these disorders to suggest that under the current nosology the major psychiatric disorders likely reflect heterogenous groups of disorders with respect to pathophysiology and etiology. Despite the invaluable leads that the neuroimaging studies have provided regarding the neurobiological bases for psychiatric disorders, they have yet to impact significantly the diagnosis or treatment of individual patients.
Physician Health Programs in the Treatment of Substance Use Disorders in Physicians
In 1974, the American Medical Association (AMA) acknowledged physician impairment from alcoholism and drug dependence occurs, and recognized alcoholism and addiction as illnesses. Physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years. This is a critically important distinction. Illness is the existence of a disease. Impairment is a functional classification and implies the inability of the person affected by disease to perform specific activities.
QTc Prolongation and Psychotropic Medications
Psychiatrists and other clinicians frequently prescribe psychotropic drugs that may prolong cardiac repolarization, thereby increasing the risk for torsades de pointes (TdP). The corrected QT interval (QTc) is the most widely used and accepted marker of TdP risk. This resource document was created in response to the paucity of strong evidence to guide clinicians in best practice prescription and monitoring of psychotropic medications that may increase risk of TdP.
Advocacy Teaching in Psychiatry Residency Training Programs
Advocacy, generically defined as the active support for a particular cause, policy, or issue, is applicable to medicine and psychiatry as physicians’ responsible use of “their expertise and influence to advance the health and well-being of individual patients, communities, and populations” (Frank, 2005). Advocacy can be undertaken from within an organization or as an outside stakeholder, and it can focus on a single theme (e.g., Barber, 2008) or more generally on issues that relate to patient needs, including the social determinants of health (e.g., Chin, 2017). Although the concept of advocacy is commonly linked to legislative advocacy, a specific arena of advocacy that seeks to influence policy and politics, it is also applicable more broadly to other activities that physicians undertake to support specific causes (e.g., community-level advocacy to avert the shutdown of a homeless shelter, interviews with the lay media as advocacy to inform public opinion).
Core Principle for Alternative Payment Models for Behavioral Health
The APA’s Position Statement enunciates 10 principles. These are presented below along with their supporting background information. The first principle declares that the predominant goals for behavioral health APMs should be defined as increasing access and improving quality of care for individuals with mental health and substance use disorders (MH/SUDs), in order to improve outcomes.
Risk-Based Gun Removal Laws
In 2014, the American Psychiatric Association (APA) published a “Resource Document on Access to Firearms by People with Mental Disorders,”1 which addressed the complex relationship between firearms, mental illness, suicide, and violence. The document highlighted the limitations of existing legislative strategies, such as the National Instant Criminal Background Check System (NICS), in combating the problems of gun-related suicide and violence in the United States. It noted that registries like NICS can be helpful in some situations, but they are minimally effective in identifying people at acute risk of harm to self or others. In addition, they can unfairly stigmatize individuals with mental illness.
Telemedicine in Psychiatry - Advocacy Priorities
The APA will advocate for: 1. Increasing telemedicine and telepsychiatry research. 2. Developing and promoting telepsychiatry best practices.Â
Physician Health Programs
This Resource Document aims to highlight some important safeguards and best practices for Physician Health Programs (PHPs) for physicians who seek help voluntarily from PHPs as well as those who are mandated participants. These suggestions are intended to help PHPs and their affiliates to align their practices and procedures with the goals of treatment and to minimize the risk of adverse outcomes, both for the public and for the physicians who participate in PHPs.
Physician Assisted Death
Over the past two decades, a number of US states have enacted statutes legalizing the practice of physician-assisted death (PAD).12 In 1997, Oregon passed the first statute that legalized PAD. Washington (2008), Vermont (2013), California (2015), and Colorado (2016) have followed suit. In addition, a state court ruling in Montana legalized PAD in 2009. In 2015, the Supreme Court of Canada ruled PAD to be legal and the Canadian Parliament subsequently enacted a law to implement PAD. In February 2017, PAD was legalized in the District of Columbia. Legalization of PAD has been proposed in about half of all states in recent years. There appears to be a broad movement to consider legalization of PAD that may lead to legislation in other states. In the United States, PAD statutes have been restricted to patients with terminal illness, typically defined as an illness that is irreversible and likely to lead to death within six months.
Mental Health and Climate Change
Climate change is recognized as one of the top threats to global health in the 21st century. Mental Health impacts of climate change are significant sources of stress for individuals and communities. The social and mental health consequences of extreme and slow-moving weather events are well documented, ranging from minimal stress and distress symptoms to clinical disorder, including depression, anxiety, post-traumatic stress, and suicidal thoughts (Arnberg et al., 2013; Fullerton et al., 2013; North et al., 2004). High risk coping behavior, such as alcohol use, has been associated with climate related weather events (Flory et al.,2009; Rohrbach et al., 2009). Intimate partner violence may increase as well, with women being particularly effected (Harville et al., 2011; Fisher, 2010). Suicidal thoughts and behavior have been shown to increase following extreme weather events (Kessler et al., 2008; Larrance et al., 2007). In addition, population displacement and migrations, breakdown of community infrastructure, food scarcity, loss of employment, and poor sense of social support and connectedness have serious consequences for mental health (Chan et al., 2015; Benight et al.,1999; Ursano et al., 2014).
Telemedicine Synchronous Video-conferencing in Psychiatry
Synchronous video-conferencing in psychiatry began during the 1950s. Synchronous video-conferencing became increasingly common during the 1970s and 1980s. By the early 2000s, the Department of Veterans Affairs was building a national telemedicine program including video-conferencing.
Ethical Considerations Regarding Internet Searches for Patient Information
The introduction of web search engines and their development in the 1990s dramatically changed the landscape of information gathering. With only a few clicks on a computer, cellphone or other device, an individual could access information on a wide range of topics in a matter of seconds, including personal information of others. To “Google” for information (i.e., to research something via Google or other search engines) has become routine in our daily endeavors. Search engines and social media such as Facebook, YouTube, Instagram, and so on, provide a ready trove of information on people, events, places and things. They encourage individuals to post personal information on these sites that can be easily accessed by others.