Resource Document on the Need to Monitor and Assess the Public Health and Safety Consequences of Legalizing Marijuana
Resource Document on Psychotherapy as an Essential Skill of Psychiatrists
Gun violence is a major public health problem in our country. Recent data indicate that 19,392 people used a gun to kill themselves in 2010, and 11,078 killed someone else with a firearm (1). In 2003, the homicide rate in the United States was seven times higher than the average of other high-income countries (2). Although concern is understandably heightened when mass tragedies occur, the daily occurrence of scores of murders and suicides due to the use of guns rarely gets the attention afforded mass tragedies.
Resource Document on the Use of Antipsychotic Medications to Treat Behavioral Disturbances in Persons with Dementia
The goal of this resource document is to address the major areas of the use of the internet in communication with patients and the public in the practice of psychiatry. The rate of change of technological capabilities and their implementation is so rapid that the workgroup believes that it would be inappropriate to promulgate fixed rules for constantly changing situations. Rather, we seek to provide some questions to be considered when implementing any new communication technology with patients or the public. This document seeks to address professional use of the internet and does not discuss issues related to psychiatrists’ use of social media and social networking sites such as Facebook or Twitter. In order to assist the practitioner, references to resource materials will be given. However, the reference is not an endorsement by either the APA or the members of the work group of the material contained therein.
The medical use of marijuana has received considerable attention as several states have voted to remove civil and criminal penalties for patients with qualifying conditions. Yet, on a national level, marijuana remains a schedule I substance under the Controlled Substances Act (CSA), the most restrictive schedule enforced by the Drug Enforcement Administration (DEA) (1). The Food and Drug Administration (FDA), responsible for approving treatments after appropriate and rigorous study, additionally does not support the use of marijuana for medical purposes. This juxtaposition of practice and policy has prompted many professional medical organizations to issue official positions on the topic. This statement reflects the position of the American Psychiatric Association (APA) on the use of marijuana for psychiatric indications. It does not cover the use of synthetic cannabis-derived medications such as Dronabinol (Marinol), which has been studied and approved by the FDA for specific indications.
Upon full implementation of the Affordable Care Act, it is estimated that more than 32 million Americans will become insured and gain access to mental health and substance abuse services at parity (1). Despite considerable gains in the number of medical school graduates entering the field of psychiatry over the past ten years, it has become clear that the workforce of psychiatrists is not large enough, acting alone, to meet the needs of patients (2,3).
Cultural psychiatry as a specific field of study relevant to the assessment and care of all patients
The comparative study of mental health and mental illness among diverse societies, nations, and cultures and the multiple interrelationships of mental disorders with cultural environments have occupied the interest of individual psychiatrists and psychiatric organizations in the U.S. and abroad for many years. The growth of international collaboration in psychiatry since World War II, the many advances in clinical methods and research, particularly in the last several decades, have greatly enhanced interest in the field, as has the rapprochement of psychiatry with cultural anthropology, sociology, and behavioral sciences. The phenomena of globalization, the impact of migration, the progress in technology and its communication products, the ease of modern international travel, and a variety of other factors has quickened the pace of development.
In May 2009, an Action paper was passed by the APA Assembly calling for the development of an APA Position Paper on the Clinical Application of Brain Imaging in Psychiatry. This action paper was developed in response to questions raised by claims being made that brain imaging technology had already reached the point that it was useful for making a clinical diagnosis and for helping in treatment selection.
After the announcement of the DSM-5 Work Group membership in May 2008, the American Psychiatric Association (APA) received many inquiries regarding the workgroup named to address the entities included under Gender Identity Disorder (GID) in versions III through IVTR of the Diagnostic and Statistical Manual of Mental Disorders™ (DSM). These inquiries most often dealt with treatment controversies regarding GID, especially in children, rather than issues related specifically to the DSM text and diagnostic criteria. In addition, the APA Committee on Gay, Lesbian, and Bisexual Issues had previously raised concerns about the lack of evidence-based guidelines for GID, and questions about whether such guidelines could and should be developed.
Ongoing stressors in the lives of physicians across the life span raise the risk for burnout, stress related illness and impairment. Psychiatrists have a unique vantage point in contributing to the overall health and wellbeing of all physicians. Recent studies have shown that physicians who personally practice healthy behaviors are significantly more likely to advise their own patients to adopt healthy behaviors. It is therefore imperative to promote the overall personal health of physicians at each stage of their development.
The APA published a Task Force report, “Clinical Aspects of the Violent Individual,” in 1974 (1). Since then, the assessment of violence risk by psychiatrists has assumed increased prominence (2, 3). At the same time, significant changes have taken place both in the contexts in which psychiatrists assess risk and in the techniques that help them do so.