87 Results
Abortion and women's reproductive health care rights
Abortion is a fact in the lives of many women. Approximately 20% of American women of childbearing age have already had an abortion, and it is estimated that one out of three American women will have had one by age 45.1 Robinson and colleagues authored a review article entitled “Is there an abortion trauma syndrome? Critiquing the evidence?” (2008)2 that exemplifies the American Psychiatric Association’s position on reproductive rights. Accordingly, the content of this Position Statement is largely based on that article and its cited references. There has been much debate
Psychiatric advance directives
Advance directives were developed in the context of end of life care and are generally associated with medical and surgical decision-making for permanently incapacitated patients. Within psychiatry, interest in advance directives has been expressed as a means of facilitating the treatment of individuals afflicted with serious mental illnesses (Appelbaum, 1979). These disorders are typified by recurrent episodes of severe, cognition-impairing symptomatology that often result in decisional incapacity. Psychiatric advance directives (PADs) hold the promise of allowing individuals with mental illness, during a time of stability, to record treatment preferences that will presumptively guide the direction of care during incapacitating periods of illness.
Integrated care of older adults with mental disorders
Elderly persons often have complex medical and psychiatric needs for which the input of different medical specialties and clinical disciplines is required. The involvement of multiple specialists gives patients access to greater expertise than any single clinician could provide; however, it presents significant challenges of coordination and integration of health care. We endorse the ideal of providing wellcoordinated interdiscipli-nary treatment to older Americans with psychiatric and medical problems but recognize that this ideal is not easily or often fully realized. In this document, we provide a brief review of the problem and describe a number of models that seek to provide exemplary care to elderly persons with psychiatric and medical problems by mobilizing and integrating the input of multiple specialties and clinical disciplines. We conclude with recommendations for policy, services design, and training.
Closing a practice at short notice: What every psychiatrist and their family should know
A psychiatrist’s death or incapacity raises immediate problems in the areas of clinical coverage, administrative responsibilities, and medical records. The time to plan for this situation is, of course before such an emergency occurs. By developing the attached guide, the APA is responding to the members’ needs by offering a member benefit that extends to the psychiatrist’s family and colleagues. This document was written to provide relevant and practical guidance to both the psychiatrist and his/her colleagues and family.
Religious/spiritual commitments and psychiatric practice
Psychiatrists should maintain respect for their patients' commitments (values, beliefs and worldviews). a. It is useful for clinicians to obtain information on the religious/spiritual commitments of their patients so that they may properly attend to them in the course of assessment, formulation, and treatment. b. Empathy for the patient's sensibilities and particular commitments is essential. Conflicts, either within the patient or within the clinician-patient relationship should be handled with a concern for the patient's vulnerability to the attitudes of the psychiatrist. c. Interpretations that concern a patient's commitments should be made with empathic respect for their meaning and importance to the patient.
The use of restraint and seclusion in correctional mental health care
This resource document discusses the use of seclusion or restraint for purposes of mental health intervention in jails and prisons, in contrast to its use for correctional purposes (i.e., specifically custody reasons).** The use of seclusion or restraint for mental health reasons is an emergency measure to prevent imminent harm to the patient or other persons when other means of control are not effective or appropriate.
Psychiatrists' responses to requests for psychiatric information in federal personnel investigations
Psychiatrists routinely receive and respond to patient authorizations to release information to third parties. However, a security clearance-related request for information differs from an ordinary release of information generally encountered in clinical practice. An ordinary release specifies records, notes, admission or discharge summaries, or other information generated in the course of clinical care. Most often, the information is to be released to another provider or facility for use in a therapeutic context, for the benefit of the individual patient. In contrast, the security clearancerelease may call for the psychiatrist to make a judgment about his or her patient (i.e., does the patient have a condition that could impair judgment or reliability in the context of safeguarding national security information, or be at risk for future violent behavior) that could be disqualifying for employment. Although this resource document deals only with requests for psychiatrists' disclosures with regard to security clearances, the similarities to other work-related evaluations (e.g., can the individual return to work, can the individual function as a police officer), or to other circumstances in which disclosures may be used for legal or administrative purposes (e.g., forensic evaluations) should be noted.
Brain imaging and child and adolescent psychiatry with special emphasis on SPECT
Although knowledge is increasing regarding specific pathways and specific brain areas involved in mental disease states, at present the use of brain imaging to study psychiatric disorders is still considered a research tool. Continued study of child and adolescent psychiatric disorders using a variety of brain imaging methods, as well as refinements in imaging techniques, may result in evidence supporting the utility of these tools for clinical work in the future. Imaging research cannot yet be used to diagnose psychiatric illness and may not be useful in clinical practice for a number of years. In the future, imaging techniques may be useful to examine medication effects and predict medication response.
Alternatives to managed care
Although knowledge is increasing regarding specific pathways and specific brain areas involved in mental disease states, at present the use of brain imaging to study psychiatric disorders is still considered a research tool. Continued study of child and adolescent psychiatric disorders using a variety of brain imaging methods, as well as refinements in imaging techniques, may result in evidence supporting the utility of these tools for clinical work in the future. Imaging research cannot yet be used to diagnose psychiatric illness and may not be useful in clinical practice for a number of years. In the future, imaging techniques may be useful to examine medication effects and predict medication response.
Guidelines for psychiatric “fitness for duty” evaluations of physicians
Psychiatrists are often called upon to evaluate a physician’s fitness for duty. Specific questions may center on the presence of psychiatric or neuropsychiatric impairment. In these cases, the psychiatrist may be asked to examine the physician, prepare a report of detailed diagnostic findings and treatment options, and offer an opinion regarding fitness for duty.
Consensus statement on "Managing the risks of repetitive transcranial stimulation"
In response to the changing managed care environment, the APA Committee on Managed Care established a subcommittee to document the changes in managed care and to begin the process of thinking about alternative healthcare financing systems. The Committee undertook writing a resource document for APA members to identify and describe the changes that are occurring in the healthcare sector and to prepare them for changes that may occur so that psychiatry can be proactive in meeting these challenges
Psychotherapy notes provision of the Health Insurance Portability and Accountability Act (HIPPA) pri
The Final HIPPA Privacy Rule defines psychotherapy notes as an official record, created for use by the mentalhealth professional for treatment, “recorded in any medium…documenting or analyzing the contents of conversation during a private counseling session or a group, joint or family counseling session that are separated from the rest of the individual’s medical record...” 45 C.F.R. § 164.501 (65 Fed. Reg. at 82805) (emphasis added). The Rule does not protect psychotherapy notes when defending a malpractice suit brought by a patient or for satisfying documentation requirements of a licensing authority because it allows disclosure without authorization for these purposes. Save for very few other exceptions (1), “psychotherapy notes” cannot be disclosed to anyone without the patient’s specific authorization. Furthermore, such authorization cannot be compelled for payment, underwriting, or plan enrollment (emphasis added).