Psychiatry RSS : Gourt

Professional sporting and entertainment events are a year round attraction in this location which has the charm of small town living but is minutes from big city life. :: Tennessee :: Candidate Direct Physician Staffing

Psychiatry Jobs - Tennessee Physician Job Type: Permanent in TN Start: Immediate Opening Shift: To be discussed at interview. Salary: This psychiatry job offers generous income guarantee and

Less Than 2 Hours to Chicago, Detroit, Outpatient Setting, Several Colleges Nearby, #5287 :: Michigan :: Timeline Recruiting

Join a program that draws patients as far as Central Indiana, Central Michigan and Chicago due to its dedicated Geriatric Psychiatry providers. This program has an established memory clinic as well

Midwest Metro with 1.3 Million Draw, Phone Call Only, World Class Academia Nearby, #5621 :: Indiana :: Timeline Recruiting

We pride ourselves in helping the members of our community achieve a quality of life in which they can take comfort. Our team of physicians, nurse practitioners and therapists practice with a strong

1+ Hour to Pittsburgh, 15 Minutes to Big East University, Leadership Available, #5169 :: West Virginia :: Timeline Recruiting

* 200K + potential * Opportunity for leadership role * Great call schedule * Employed hospital position with a private practice feel * Signing bonus and relocation to make your transition easier

Medical Directorship Available, 45 Minutes to Twin Cities, $50K Signing Bonus, #5281 :: Wisconsin :: Timeline Recruiting

Have the ability to step into an excellent practice opportunity that will offer you personal growth and the satisfaction that comes from a healthy blend of stimulating work and leisure time. * $195,000

Minneapolis Bedroom Community, $50K Sign-On, Medical Director Role, #5281 :: Wisconsin :: Timeline Recruiting

Cincinnati, Award-Winning Institution, More than 90 Golf Courses!, #5027 :: Ohio :: Timeline Recruiting

Step into an excellent practice opportunity that offers fulfillment on many levels: professional growth, financial rewards and the personal satisfaction that comes from a healthy blend of hard work

Northern Indiana, 40 Miles to Chicago, Predominantly Outpatient, #5491 :: Indiana :: Timeline Recruiting

Join a multidisciplinary group of physicians that devote themselves to the medical profession and their patients. With strong clinical abilities and advanced facilities, we offer the highest quality

Tele-Psychiatry, 100% Outpatient, Midwest Adult Psychiatrist, #5460 :: Missouri :: Timeline Recruiting

We are recruiting two Adult Psychiatrists to provide outpatient services to our Mid-Missouri communities. Boasting 34 offices in 32 counties we offer a full continuum of care that includes outpatient

1 hour to Pittsburgh, Largest State-Owned University in Town, #5385 :: Pennsylvania :: Timeline Recruiting

Join a medical center that is consistently recognized as one of the best places to work in the state and in the nation. You and your family will be able to rest in the comforts of working for one of

Easy drive to Boston :: New Hampshire :: Medical Search International

Outstanding situation for a BC/BE Psychiatrist with Geriatric training and/or interest. Mostly outpatient. Easy schedule. Great compensation and benefits. No personal income tax and no sales tax in State

Great Location :: Arkansas :: MedBizJob.com

This is a salaried position with bonus potential. The opportunity includes nursing home consults, 12- bed Geriatric Psychiatric Unit, outpatient and inpatient consults. Call coverage is ten (10) days

Jacksonville :: Florida :: MedBizJob.com

We are currently seeking a BC/BE Internal Medicine trained physician who can provide the following: * Effective leadership to their facility * Commitment to the success of their practice group *

Northwestern :: Arkansas :: Nationwide Physician Recruitment

I have an outstanding opportunity for a general Psychiatrist in northwestern Arkansas. The population is 58,000 and the area has been recognized in many polls as one of the most desirable places to

Boston area :: Massachusetts :: Nationwide Physician Recruitment

2 outstanding full-time opportunities with this very stable client in the Boston area: STAFF PSYCHIATRY: should have general psychiatry, child / adolescent, addiction, dual diagnosis, and geriatric

Nationwide :: Texas :: Physician Referral Network

Physician Referral Network is your best source to learn about the latest practice opportunities. We are not a recruiting firm, so we promise you'll never be pressured to look at or take a position that

St. Louis :: Missouri :: Nationwide Physician Recruitment

Downtown St. Louis is just minutes away with multiple universities and cultural amenities. This is a hospital employed setting with a traditional inpatient/outpatient mix. Regional Medical Center

Houston :: Texas :: MedBizJob.com

We are currently seeking a BC/BE psychiatric inpatient hospitalist who can provide the following: * Effective leadership to their facility * Commitment to the success of their practice group * The

Central :: Maine :: Healthcare Recruitment Counselors, LLC

Psychiatrist-Adult, and Child-Maine Adult: seeking a BC/BE adult psychiatrist with interests in inpatient psychiatry or Outpatient psychiatry/substance abuse. You will be joining a staff of 7 employed

Dothan :: Alabama :: Baumann & Associates

Seeking 2 more staff psychiatrists 1:3 call in an employed position to manage patients in a primarily inpatient setting with 1-2 afternoons dedicated to outpatient assessment. The Behavioral Medicine

Metro Delaware :: Delaware :: Medical Search International

Jan, Feb and March 2009 / Part Time Psychiatrist Adult In-Patient Flexible Hours Monday, Wednesday Friday for 8 hours each day or Monday-Friday 4 hours each day This is a Day hospital or partial

Not Disclosed :: Pennsylvania :: Locum Medical Group

A psychiatrist is needed on a locum tenens basis at the VA medical center in Lebanon, Pennsylvania. The assignment will begin in February of 2010 and will continue until May 30, 2010. Psychiatry patients

Not Disclosed :: West Virginia :: Locum Medical Group

A hospital in southern West Virginia is seeking a Psychiatrist for a locum tenens to permanent opportunity in its expanding Psychiatry department. This hospital is licensed for 600-beds. The Psychiatrist

Not Disclosed :: West Virginia :: Locum Medical Group

A hospital in northern West Virginia is seeking a Psychiatrist for a locum tenens-to-permanent opportunity in its expanding Psychiatry department. This hospital is licensed for 126 beds. This Psychiatrist

Not Disclosed :: Virginia :: Locum Medical Group

A hospital in eastern Virginia is seeking a Psychiatrist for a locum-to-permanent opportunity in its expanding Psychiatry department. This hospital is licensed for 271 beds. The Psychiatrist will be responsible

Not Disclosed :: Texas :: Locum Medical Group

A hospital in northeastern Texas is seeking a Psychiatrist for a locum-to-permanent opportunity in its expanding Psychiatry department. This hospital is licensed for 360 beds. The Psychiatrist will be

Not Disclosed :: Washington :: Locum Medical Group

A hospital in southern Washington is seeking a Psychiatrist for a locum-to-permanent opportunity in its expanding Psychiatry department. This hospital is licensed for 64 beds. The Psychiatrist will be

Not Disclosed :: North Carolina :: Locum Medical Group

A hospital in western North Carolina is seeking a Psychiatrist for a locum-to-permanent opportunity in its expanding Psychiatry department. This hospital is licensed for 143 beds. The Psychiatrist will

Not Disclosed :: Kentucky :: Locum Medical Group

A hospital in western Kentucky is seeking a Psychiatrist for a locum-to-permanent opportunity in its expanding Psychiatry department. This hospital is licensed for 271 beds. The Psychiatrist will be responsible

Not Disclosed :: Montana :: Locum Medical Group

A inpatient Psychiatry opportunity is available in Montana starting April 2010 and continuing ongoing. The group is looking for ongoing locum, locum-to-perm and/or permanent candidates. The two units

New Facility :: New Mexico :: Locum Leaders

Locum Leaders seeks a psychiatrist for ongoing locums coverage in New Mexico. It is a new adult inpatient 10 bed unit. Monday Friday and night beeper call. Occurrence malpractice insurance, prompt weekly

Northeastern :: New York :: Medical Search International

We have an immediate need in upstate NY for a Psychatrist. Our client is recruiting on a full time basis but needs some locums help until the ideal perm candidate is identified and has started work. This

Southeast :: Alabama :: Medical Search International

Facility in Southeast Alabama is needing Psych Locum Tenens coverage 1 weekend per month ongoing. The weekend can be flexible. Coverage would be 5pm Friday-8am Monday. Its inpatient work, making rounds

Kentucky :: Kentucky :: Medical Search International

Psychiatry locums coverage needed in Kentucky ASAP ongoing. -The practice is 100% inpatient. -VERY competitive pay -We cover malpractice, housing and lodging **If you are not available but you

North :: Illinois :: Medical Search International

A great client in Illinois needs an adult outpatient psychiatry locums starting ASAP for ongoing coverage. Very competitive pay, we will make it worth your while! Here are the Highlights of working for

Classification [From the Editor]

Revision of the classification of mental disorders in ICD-11 and DSM-V: work in progress [Editorials]

This editorial summarises the work done to prepare ICD–11 and DSM–V (which should be published in 2015 and 2013 respectively). It gives a brief description of the structures that have been put in place by the World Health Organization and by the American Psychiatric Association and lists the issues and challenges that face the two organisations on their road to the revisions of the classifications. These include dilemmas about the ways of presentation of the revisions (e.g. whether dimensions should be added to categories or even replace them), about different versions of the classifications (e.g. the primary care and research versions), about ways to ensure that the best of evidence as well as experience are taken into account in drafting the revision and many other issues that will have to be resolved in the immediate future.

Medical professionalism in psychiatry [Editorials]

The principles of primacy of patient welfare, patient autonomy and social justice are fundamental to medical and psychiatric professionalism. Medical professionalism is also about encouraging and celebrating good practice. As a set of values and behaviours on the one hand, and relationships with patients, carers and other stakeholders on the other, the implicit contract between psychiatry and society needs to be renegotiated regularly. Serious threats to medical professionalism in the past 30 years have led to the demoralisation of professionals. Learned helplessness and a perceived loss of autonomy have been recognised as important factors in the ‘loss’ of professionalism. Psychiatry as a profession needs to identify its core attributes, skills and competencies. Professionalism should allow individuals to set and maintain their own standards of care.

The classification of mental disorder: a simpler system for DSM-V and ICD-11 [Articles]

This article proposes a simplification to the chapter structure of current classifications of mental disorder, which cause unnecessary estimates of ‘comorbidity’ and pay major attention to symptom similarity as a criterion for deciding on groupings. A simpler system, taking account of recent developments in aetiology, is proposed. There is at present no simple solution to the problems posed by the structure of our classification, but the advantages as well as the shortcomings of changing our approach to diagnosis are discussed.

Robust empirical data and clinical utility: the only drivers of change: COMMENTARY ON... THE CLASSIFICATION OF MENTAL DISORDER [Commentary]

We have arrived at our current descriptive classifications, with their many and varied array of categories, through the committee processes of DSM and ICD. To date, expert opinion, rather than solid science, has been the driver for change and this helps to explain the bewildering number of diagnostic categories and the fact that many patients meet criteria for several categories. Over the coming years, advances in neuroscience will offer the opportunity to base classification on robust evidence with diagnostic entities mapping more closely onto the workings of the brain. There are major shortcomings to the current classifications but all changes come at a cost to their users. We should be fully aware of the shortcomings and be thinking about the future. However, major changes to classification should await the emergence of robust empirical data and proven clinical utility. This will be the best way to benefit patients.

From Perceval's Narrative [In Other Words]

Cognitive-behavioural therapy with children, young people and families: from individual to systemic therapy [Articles]

In recent decades there has been much interest in using cognitive–behavioural therapy (CBT) with children, young people and families. CBT is a collaborative approach, based on shared building of a hypothesis (the formulation) about causative and maintaining factors. When working with children, young people, their families and wider systems (e.g. a support network), therapy should incorporate interpersonal, family and systemic factors, together with developmental and attachment issues and phenomena more commonly expressed through other psychotherapeutic modalities. There is growing clinical experience that systemic cognitive–behavioural formulation can lead to systemic-process working on an individual, parent–child, family or wider-system basis. Formal evaluation of this approach is needed to consider where it fits among established psychotherapies in mental health work with young people and their families.

Asperger syndrome and criminal behaviour [Articles]

The importance of considering antisocial behaviour among people with autism-spectrum disorders is apparent from the significant number of case reports and case series describing criminal behaviour of people with a diagnosis of Asperger syndrome. The evidence so far does not support a specific association between the syndrome and criminal offending. However, a small yet significant number of offenders with autism who engage in illegal behaviour find themselves socially excluded or detained in secure provisions for prolonged periods. This article gives an overview of the scant empirical evidence relating to criminality within the context of Asperger syndrome, and offers suggestions for managing the syndrome in mentally disordered offenders.

Understanding offenders with autism-spectrum disorders: what can forensic services do?: COMMENTARY ON... ASPERGER SYNDROME AND CRIMINAL BEHAVIOUR [Commentary]

This commentary aims to support and elaborate on some of the specific issues raised by Dein & Woodbury-Smith. Although I agree with many of their comments, I believe that the role of neuro-psychological and sensory impairments, as well as dysfunctional coping strategies among individuals with an autism-spectrum disorder who offend, need to be expanded from a psychological perspective. In my experience, the assessment of these factors plays a crucial role in guiding opinions on mental capacity, individual interventions, risk assessment and management. Elements of psychopathy in autism also require clarification. It could be argued that by understanding these issues, any attempts at social inclusion and preventing offending will be more successful.

Autism in fiction and autobiography [Articles]

Many memorable characters in Western culture could be viewed as having features of autism or Asperger syndrome. In spite of the familiarity of autistic stereotypes such as Star Trek’s Mr Spock, more completely described characters with autism are still unusual. In recent years there has been a growing interest in autism, mirrored by an increase in depictions of autism in popular works of fiction and autobiography. In this article I will outline the issues that have preoccupied writers and the techniques they have used to demonstrate autistic difference. Some writers have illuminated aspects of the autistic triad of social impairment, abnormalities of language and need for sameness. Other writers have opened our eyes to the autistic world view in its strangeness and richness. Still more have started to examine prejudice, disability rights and the implications of an international autism community. As in other areas of mental health, literature can help inform, entertain and question our attitudes and values.

Discrimination against people with mental illness: what can psychiatrists do? [Articles]

This article discusses the evidence that experiences of stigmatisation and discrimination among people with mental illnesses are common and may be severe. Furthermore, there are growing concerns that people with mental illness receive second-class physical healthcare. Beyond this, some aspects of psychiatric practice are reported as being insensitive, disrespectful or even disabling. We consider whether such claims are justified and what psychiatrists can do, directly and indirectly, to reduce stigma and discrimination and improve our practice.

Challenging healthcare discrimination: COMMENTARY ON ... DISCRIMINATION AGAINST PEOPLE WITH MENTAL ILLNESS [Commentary]

Stigma-discrimination against people with mental health problems is more prevalent and damaging than the weaker ‘stigma by association’ experienced by mental healthcare professionals. Not only are patients reluctant to seek psychiatric help, but they are shunned by society and discriminated against by general healthcare services when they do. Other clinicians see psychiatric services as a last resort and government funding of these services is disproportionately low. Psychiatrists must engage in anti-stigma activities. I suggest ways in which, both in the clinical arena and in the wider context of education and society, psychiatrists can challenge clinicians’ and the public’s value judgements of psychiatric patients.

Prescribing antipsychotics for children and adolescents [Articles]

The prescription of antipsychotic medication in children and adolescents (<18 years of age) has increased immensely for a wide range of disorders including psychoses, bipolar disorder, conduct disorder, pervasive developmental disorder and obsessive–compulsive disorder. This has led to some concerns particularly as the evidence base in some areas is not strong, and antipsychotic medication – both first generation (FGA) and second generation (SGA) – is associated with considerable side-effects. Evidence from an increasing number of randomised controlled trials (RCTs) points to therapeutic efficacy with moderate to large effect sizes. However, some RCTs have a small number of participants, are of short duration, and many are industry funded. The use of antipsychotics alongside psychosocial interventions can be recommended in certain disorders, provided there is continued, careful monitoring. It is important to note, however, that for many conditions the use of antipsychotics is not licensed in the UK.

Combining antidepressants: understanding drug interactions is the sine qua non [Correspondence]

Authors' reply [Correspondence]

In This Issue [In This Issue]

Elevated Suicide Rate Among HIV-Positive Persons Despite Benefits of Antiretroviral Therapy: Implications for a Stress and Coping Model of Suicide [Editorials]

Strategies to Close the "Mortality Gap" [Editorials]

Investigating the Cognitive Antecedents of Schizophrenia [Editorials]

The Use of Depot Medications in the Treatment of Schizophrenia [Editorials]

ECT in the Treatment of a Patient With Catatonia: Consent and Complications [Clinical Case Conference]

Acute catatonia in an adolescent or young adult can present complex clinical challenges. Prominent issues include those involving diagnosis, timely and effective treatment, and diminished capacity to provide consent. The authors describe a 19-year-old woman presenting initially with manic excitement followed by a lengthy period of mutism, immobility, and food and fluid refusal. Elevated temperature, an elevated creatine phosphokinase level, and autonomic dysfunction led to consideration of a malignant catatonic syndrome. The patient manifested rigidity accompanied by posturing and waxy flexibility. Neurologic, medical, and laboratory evaluations failed to identify an organic cause for the likely catatonia. Treatment with amantadine, bromocriptine, and lorazepam was unsuccessful. ECT was deemed appropriate but required emergency guardianship because of the patient's inability to provide consent. At the initial ECT session, the elicited seizure was followed by an episode of torsade de pointes requiring immediate cardioversion. In reviewing the ECT complication, it appeared that muscle damage due to catatonic immobility led to acute hyperkalemia with the administration of succinylcholine. Discussions were held with the patient's guardian outlining the clinical issues and the risks of additional ECT. The patient responded to eight subsequent ECT sessions administered with rocuronium, a nondepolarizing muscle relaxant. The authors provide a brief review of the diagnosis and treatment of catatonia and address issues surrounding ECT, cardiac effects, use of muscle relaxants, and the consent process.

Psychiatric Journals in China [Images in Psychiatry]

The Development of the Feighner Criteria: A Historical Perspective [Reviews and Overviews]

This essay outlines the historical context in which the Feighner criteria emerged; reconstructs, as far as possible, the process by which the criteria were developed; and traces the influence the criteria had on subsequent developments in American psychiatry. In the 1950s, when American psychiatry under psychoanalytic dominance had little interest in psychiatric diagnosis, Edwin Gildea recruited to the Department of Psychiatry at Washington University faculty who advocated a medical model for psychiatry in which diagnosis had a central role. In 1967, at the urging of the then-resident John Feighner, a discussion group led by Eli Robins and including Sam Guze, George Winokur, Robert Woodruff, and Rod Muñoz began meeting with the initial goal of writing a review of prior key contributions to psychiatric diagnosis. In their meetings over the next year, the task soon shifted to the development of a set of new diagnostic criteria. For three diagnoses, major depression, antisocial personality disorder, and alcoholism, the authors could identify the original criteria from which this group worked and the rationale for many of the changes they introduced. Published in 1972, the Feighner criteria were soon widely cited and used in research, and they formed the basis for the development of the Research Diagnostic Criteria, which in turn were central to the development of DSM-III. The team that developed the Feighner criteria made three key contributions to psychiatry: the systematic use of operationalized diagnostic criteria; the reintroduction of an emphasis on illness course and outcome; and an emphasis on the need, whenever possible, to base diagnostic criteria on empirical evidence.

Suicide in HIV-Infected Individuals and the General Population in Switzerland, 1988-2008 [Articles]

Objective High rates of suicide have been described in HIV-infected patients, but it is unclear to what extent the introduction of highly active antiretroviral therapy (HAART) has affected suicide rates. The authors examined time trends and predictors of suicide in the pre-HAART (1988–1995) and HAART (1996–2008) eras in HIV-infected patients and the general population in Switzerland. Method The authors analyzed data from the Swiss HIV Cohort Study and the Swiss National Cohort, a longitudinal study of mortality in the Swiss general population. The authors calculated standardized mortality ratios comparing HIV-infected patients with the general population and used Poisson regression to identify risk factors for suicide. Results From 1988 to 2008, 15,275 patients were followed in the Swiss HIV Cohort Study for a median duration of 4.7 years. Of these, 150 died by suicide (rate 158.4 per 100,000 person-years). In men, standardized mortality ratios declined from 13.7 (95% CI=11.0–17.0) in the pre-HAART era to 3.5 (95% CI=2.5–4.8) in the late HAART era. In women, ratios declined from 11.6 (95% CI=6.4–20.9) to 5.7 (95% CI=3.2–10.3). In both periods, suicide rates tended to be higher in older patients, in men, in injection drug users, and in patients with advanced clinical stage of HIV illness. An increase in CD4 cell counts was associated with a reduced risk of suicide. Conclusions Suicide rates decreased significantly with the introduction of HAART, but they remain above the rate observed in the general population, and risk factors for suicide remain similar. HIV-infected patients remain an important target group for suicide prevention.

A Randomized Trial of Medical Care Management for Community Mental Health Settings: The Primary Care Access, Referral, and Evaluation (PCARE) Study [Articles]

Objective Poor quality of healthcare contributes to impaired health and excess mortality in individuals with severe mental disorders. The authors tested a population-based medical care management intervention designed to improve primary medical care in community mental health settings. Method A total of 407 subjects with severe mental illness at an urban community mental health center were randomly assigned to either the medical care management intervention or usual care. For individuals in the intervention group, care managers provided communication and advocacy with medical providers, health education, and support in overcoming system-level fragmentation and barriers to primary medical care. Results At a 12-month follow-up evaluation, the intervention group received an average of 58.7% of recommended preventive services compared with a rate of 21.8% in the usual care group. They also received a significantly higher proportion of evidence-based services for cardiometabolic conditions (34.9% versus 27.7%) and were more likely to have a primary care provider (71.2% versus 51.9%). The intervention group showed significant improvement on the SF-36 mental component summary (8.0% [versus a 1.1% decline in the usual care group]) and a nonsignificant improvement on the SF-36 physical component summary. Among subjects with available laboratory data, scores on the Framingham Cardiovascular Risk Index were significantly better in the intervention group (6.9%) than the usual care group (9.8%). Conclusions Medical care management was associated with significant improvements in the quality and outcomes of primary care. These findings suggest that care management is a promising approach for improving medical care for patients treated in community mental health settings.

Static and Dynamic Cognitive Deficits in Childhood Preceding Adult Schizophrenia: A 30-Year Study [Articles]

Objective Premorbid cognitive deficits in schizophrenia are well documented and have been interpreted as supporting a neurodevelopmental etiological model. The authors investigated the following three unresolved questions about premorbid cognitive deficits: What is their developmental course? Do all premorbid cognitive deficits follow the same course? Are premorbid cognitive deficits specific to schizophrenia or shared by other psychiatric disorders? Method Participants were members of a representative cohort of 1,037 males and females born between 1972 and 1973 in Dunedin, New Zealand. Cohort members underwent follow-up evaluations at specific intervals from age 3 to 32 years, with a 96% retention rate. Cognitive development was analyzed and compared in children who later developed schizophrenia or recurrent depression as well as in healthy comparison subjects. Results Children who developed adult schizophrenia exhibited developmental deficits (i.e., static cognitive impairments that emerge early and remain stable) on tests indexing verbal and visual knowledge acquisition, reasoning, and conceptualization. In addition, these children exhibited developmental lags (i.e., growth that is slower relative to healthy comparison subjects) on tests indexing processing speed, attention, visual-spatial problem solving ability, and working memory. These two premorbid cognitive patterns were not observed in children who later developed recurrent depression. Conclusions These findings suggest that the origins of schizophrenia include two interrelated developmental processes evident from childhood to early adolescence (ages 7–13 years). Children who will grow up to develop adult schizophrenia enter primary school struggling with verbal reasoning and lag further behind their peers in working memory, attention, and processing speed as they get older.

A Randomized, Controlled Trial of Computer-Assisted Cognitive Remediation for Schizophrenia [Articles]

Objective There is considerable interest in cognitive remediation for schizophrenia, but its essential components are still unclear. The goal of the current study was to develop a broadly targeted computer-assisted cognitive remediation program and conduct a rigorous clinical trial in a large group of schizophrenia patients. Method Sixty-nine people with schizophrenia or schizoaffective disorder were randomly assigned to 36 sessions of computer-assisted cognitive remediation or an active control condition. Remediation broadly targeted cognitive and everyday performance by providing supportive, graduated training and practice in selecting, executing, and monitoring cognitive operations. It used engaging computer-based cognitive exercises and one-on-one training. A total of 61 individuals (34 in remediation group, 27 in control group) engaged in treatment, completed posttreatment assessments, and were included in intent-to-treat analyses. Primary outcomes were remediation exercise metrics, neuropsychological composites (episodic memory, working memory, attention, executive functioning, and processing speed), and proxy measures of community functioning. Results Regression modeling indicated that performance on eight of 10 exercise metrics improved significantly more in the remediation condition than in the control condition. The mean effect size, favoring the remediation condition, was 0.53 across all 10 metrics. However, there were no significant benefits of cognitive remediation on any neuropsychological or functional outcome measure, either immediately after treatment or at the 3-month follow-up. Conclusions Cognitive remediation for people with schizophrenia was effective in improving performance on computer exercises, but the benefits of training did not generalize to broader neuropsychological or functional outcome measures. The evidence for this treatment approach remains mixed.

Olanzapine Long-Acting Injection: A 24-Week, Randomized, Double-Blind Trial of Maintenance Treatment in Patients With Schizophrenia [Articles]

Objective The purpose of the present study was to evaluate the efficacy and tolerability of olanzapine long-acting injection for maintenance treatment of schizophrenia. Method Outpatients with schizophrenia who had maintained stability on an oral regimen of olanzapine (10, 15, or 20 mg/day) for 4 to 8 weeks were randomly assigned to 24 weeks of double-blind treatment with "low" (150 mg every 2 weeks; N=140), "medium" (405 mg every 4 weeks; N=318), or "high" (300 mg every 2 weeks; N=141) doses of olanzapine long-acting injection; a very low reference dose of olanzapine long-acting injection (45 mg every 4 weeks; N=144); or their stabilized dose of oral olanzapine (N=322). Rates of and time to psychotic exacerbation were estimated using Kaplan-Meier methodology. Results At 24 weeks, the majority of oral olanzapine-treated patients (93%), as well as most olanzapine long-acting injection-treated patients receiving high (95%), medium (90%), low (84%), and very low doses (69%), remained exacerbation free, with the therapeutic 4-week regimen (medium dose) and pooled 2-week regimen (low and high doses) demonstrating efficacy similar to that of oral olanzapine as well as to each other. The three standard long-acting doses were superior to the very low reference dose based on time to exacerbation. Incidence of weight gain ≥7% of baseline was 21% for oral olanzapine compared with 21%, 15%, 16%, and 8% for the high, medium, low, and very low olanzapine long-acting treatment groups, respectively. No clinically significant differences were observed between the long-acting injection and oral olanzapine groups in general safety parameters. Few injection-site reactions occurred (3%). Two patients experienced sedation and delirium consistent with olanzapine overdose following possible accidental intravascular injection. Conclusions Olanzapine long-acting injection was efficacious in maintenance treatment of schizophrenia for up to 24 weeks, with a safety profile similar to oral olanzapine except for injection-related adverse events.

Association of FKBP5 Polymorphisms With Suicidal Events in the Treatment of Resistant Depression in Adolescents (TORDIA) Study [Articles]

Objective The authors sought to assess the relationship between candidate genes and two clinical outcomes, namely, symptomatic improvement and the occurrence of suicidal events, in a sample of treatment-resistant depressed adolescents. Method A subsample of depressed adolescents participating in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) trial, 155 of whom were of European origin, were genotyped with respect to 21 polymorphisms on 12 genes that have a reported association with depression, treatment response, or suicidal events. Participants had not responded to a previous adequate trial with an antidepressant and were randomized to receive either another selective serotonin reuptake inhibitor or venlafaxine, with or without cognitive-behavioral therapy (CBT). Single-nucleotide polymorphism (SNP) analyses were conducted using PLINK with permutation procedures. Results No relationship was observed between any polymorphism and response to treatment. The FKBP5 (which codes for a protein causing subsensitivity of the glucocorticoid receptor) rs1360780TT and rs3800373GG genotypes were associated with suicidal events (N=18), even after controlling for treatment effects and relevant covariates. These two SNPs were in significant linkage disequilibrium (r=0.91). Conclusions The FKBP5 genotypes associated with suicidal events in this study have been reported by others to cause the greatest degree of glucocorticoid receptor subsensitivity. These results are consistent with those of other studies linking alterations in the hypothalamic-pituitary-adrenal axis with suicidal behavior. The small number of events and lack of a placebo condition make these results preliminary. Replication with a larger sample and a placebo condition is needed to assess whether these events are related to treatment.

Risk of Death by Unnatural Causes During Early Childhood in Offspring of Parents With Mental Illness [Articles]

Objective Limited evidence reveals an elevated mortality risk in offspring of psychiatric patients after infancy. This nationwide population-based study in Taiwan aimed to investigate mortality risk in preschool children up to age 5 whose parents have severe mental illness. Method Three nationwide population-based data sets were linked. A total of 3,166 children with one or both parents having schizophrenia or an affective disorder were identified, together with a comparison cohort of 25,328 children matched with the study group in terms of maternal age and year of delivery. Cox proportional hazard regressions were performed to compute hazard ratios, with adjustment for sociodemographic characteristics and maternal medical comorbidities. Results During the preschool years, 54 (1.7%) deaths were documented among offspring of parents with severe mental illness and 155 (0.6%) in the comparison cohort. Parental mental illness was independently associated with a risk of death nearly 2.4 times higher (95% CI=1.72–3.28) than in the comparison cohort. The association was even more marked for unnatural causes of death, in which the mortality risk was 8.35 times greater (95% CI=4.04–17.24) in children of affected parents than in the comparison cohort. The proportional mortality rates were as high as 20.4% and 11.1% for accident and homicide, respectively, among offspring exposed to parental mental illness. Conclusions An elevated mortality risk, especially from unnatural causes of death, was identified for offspring of parents with severe mental illness during the preschool years in an Asian society. There is an urgent need for multidisciplinary team approaches and risk management strategies to support psychiatric patients who are having difficulty with the transition to parenthood.

A Neural Signature of Anorexia Nervosa in the Ventral Striatal Reward System [Articles]

Objective Animal studies assessing mechanisms of self-starvation under conditions of stress and diet suggest a pivotal role for the mesolimbic reward system in the maintenance of core symptoms in anorexia nervosa, which is corroborated by initial empirical evidence in human studies. The authors examined activity in the ventral striatal system in response to disease-specific stimuli in women with acute anorexia nervosa. Method Participants were 14 women with acute anorexia nervosa and 14 matched healthy comparison women who underwent functional magnetic resonance imaging (fMRI) during evaluation of visual stimuli depicting a female body with underweight, normal weight, and overweight canonical whole-body features according to standardized body mass indices. Participants were required to process each stimulus in a self-referring way. Ratings for each weight category were used as the control task. Results Behaviorally, women with anorexia nervosa provided significantly higher positive ratings in response to underweight stimuli than in response to normal-weight stimuli, while healthy comparison women showed greater preference for normal-weight stimuli relative to underweight stimuli. Functionally, ventral striatal activity demonstrated a highly significant group-by-stimulus interaction for underweight and normal-weight stimuli. In women with anorexia nervosa, activation was higher during processing of underweight stimuli compared with normal-weight stimuli. The reverse pattern was observed in healthy comparison women. Conclusions These findings are consistent with predictions in animal studies of the pivotal role of the human reward system in anorexia nervosa and thus support theories of starvation dependence in maintenance of the disorder.

Increased Cardiac Death or Decreased Motor Vehicle Accidents? [Letters to the Editor]

Stimulant Medication Use and Sudden Death in Youths: Considering Unmeasured Covariates [Letters to the Editor]

Increased Risk of Sudden Death Among Youths and Stimulant Use: Determining Alternate Potential Factors [Letters to the Editor]

Dr. Gould Replies [Letters to the Editor]

Coalitional Affiliation Rather Than Religiosity Might Explain the Heritability of Church Attendance [Letters to the Editor]

Antipsychotic Drugs for Depression? [Letters to the Editor]

Drs. Nelson and Papakostas Reply [Letters to the Editor]

Beta-Blockers and Depression [Letters to the Editor]

Dr. Kent Replies [Letters to the Editor]

Psychiatrist on the Road: Encounters in Healing and Healthcare [Book Forum]

Ethno-Psychopharmacology: Advances in Current Practice [Book Forum]

Cognitive Dysfunction in Bipolar Disorder: A Guide for Clinicians [Book Forum]

Back to Life, Back to Normality: Cognitive Therapy, Recovery, and Psychosis [Book Forum]

Books Received [Books Received]

APA Council Reports [APA Official Actions]

Association of Genetic Variants in the Neurotrophic Receptor-Encoding Gene NTRK2 and a Lifetime History of Suicide Attempts in Depressed Patients [Original Article]

Context A consistent body of evidence supports a role of reduced neurotrophic signaling in the pathophysiology of major depressive disorder (MDD) and suicidal behavior. Especially in suicide victims, lower postmortem brain messenger RNA and protein levels of neurotrophins and their receptors have been reported.Objective To determine whether the brain-derived neurotrophic factor (BDNF) gene or its high-affinity receptor gene, receptor tyrosine kinase 2 (NTRK2), confer risk for suicide attempt (SA) and MDD by investigating common genetic variants in these loci.Design Eighty-three tagging single-nucleotide polymorphisms (SNPs) covering the genetic variability of these loci in European populations were assessed in a case-control association design.Setting Inpatients and screened control subjects.Participants The discovery sample consisted of 394 depressed patients, of whom 113 had SA, and 366 matched healthy control subjects. The replication studies comprised 744 German patients with MDD and 921 African American nonpsychiatric clinic patients, of whom 152 and 119 were positive for SA, respectively.Interventions Blood or saliva samples were collected from each participant for DNA extraction and genotyping.Main Outcome Measures Associations of SNPs in BDNF and NTRK2 with SA and MDD.Results Independent SNPs within NTRK2 were associated with SA among depressed patients of the discovery sample that could be confirmed in both the German and African American replication samples. Multilocus interaction analysis revealed that single SNP associations within this locus contribute to the risk of SA in a multiplicative and interactive fashion (P = 4.7 x 10–7 for a 3-SNP model in the combined German sample). The effect size was 4.5 (95% confidence interval, 2.1-9.8) when patients carrying risk genotypes in all 3 markers were compared with those without any of the 3 risk genotypes.Conclusions Our results suggest that a combination of several independent risk alleles within the NTRK2 locus is associated with SA in depressed patients, further supporting a role of neurotrophins in the pathophysiology of suicide.Published online February 1, 2010 (doi:10.1001/archgenpsychiatry.2009.201).

About This Journal [About This Journal]

This Month in Archives of General Psychiatry [This Month in Archives of General Psychiatry]

Pygmalion in Love With His Statue [Art and Images in Psychiatry]

As the Twig Is Bent, the Tree Inclines: Adult Mental Health Consequences of Childhood Adversity [Commentary]

Childhood Adversities and Adult Psychiatric Disorders in the National Comorbidity Survey Replication I: Associations With First Onset of DSM-IV Disorders [Original Article]

Context Although significant associations of childhood adversities (CAs) with adult mental disorders have been documented consistently in epidemiological surveys, these studies generally have examined only 1 CA per study. Because CAs are highly clustered, this approach results in overestimating the importance of individual CAs. Multivariate CA studies have been based on insufficiently complex models. Objective To examine the joint associations of 12 retrospectively reported CAs with the first onset of DSM-IV disorders in the National Comorbidity Survey Replication using substantively complex multivariate models. Design Cross-sectional community survey with retrospective reports of CAs and lifetime DSM-IV disorders. Setting Household population in the United States. Participants Nationally representative sample of 9282 adults. Main Outcome Measures Lifetime prevalences of 20 DSM-IV anxiety, mood, disruptive behavior, and substance use disorders assessed using the Composite International Diagnostic Interview. Results The CAs studied were highly prevalent and intercorrelated. The CAs in a maladaptive family functioning (MFF) cluster (parental mental illness, substance abuse disorder, and criminality; family violence; physical abuse; sexual abuse; and neglect) were the strongest correlates of disorder onset. The best-fitting model included terms for each type of CA, number of MFF CAs, and number of other CAs. Multiple MFF CAs had significant subadditive associations with disorder onset. Little specificity was found for particular CAs with particular disorders. Associations declined in magnitude with life course stage and number of previous lifetime disorders but increased with length of recall. Simulations suggest that CAs are associated with 44.6% of all childhood-onset disorders and with 25.9% to 32.0% of later-onset disorders. Conclusions The fact that associations increased with length of recall raises the possibility of recall bias inflating estimates. Even considering this, the results suggest that CAs have powerful and often subadditive associations with the onset of many types of largely primary mental disorders throughout the life course.

Childhood Adversities and Adult Psychiatric Disorders in the National Comorbidity Survey Replication II: Associations With Persistence of DSM-IV Disorders [Original Article]

Context Although significant associations of childhood adversities (CAs) with adult mental disorders have been widely documented, associations of CAs with onset and persistence of disorders have not been distinguished. This distinction is important for conceptual and practical purposes. Objective To examine the multivariate associations of 12 retrospectively reported CAs with persistence of adult DSM-IV disorders in the National Comorbidity Survey Replication. Design Cross-sectional community survey. Setting Household population in the United States. Participants Nationally representative sample of 5692 adults. Main Outcome Measures Recency of episodes was assessed separately for each of 20 lifetime DSM-IV mood, anxiety, disruptive behavior, and substance use disorders in respondents with a lifetime history of these disorders using the Composite International Diagnostic Interview. Predictors of persistence were examined using backward recurrence survival models to predict time since most recent episode controlling for age at onset and time since onset. Results The CAs involving maladaptive family functioning (parental mental illness, substance use disorder, criminality, family violence, physical and sexual abuse, and neglect) but not other CAs were significantly but modestly related to persistence of mood, substance abuse, and anxiety disorders. Number of maladaptive family functioning CAs had statistically significant, but again substantively modest, subadditive associations with the same outcomes. Exposure to multiple other CAs was significantly associated with persistence of mood and anxiety disorders. Associations remained statistically significant throughout the life course, although the substantive size of associations indicated by simulations showing time to most recent episode would increase by only 1.6% (from a mean of 8.3 years to a mean of 8.4 years) in the absence of CAs. Conclusions The overall statistically significant associations of CAs with adult DSM-IV/Composite International Diagnostic Interview disorders are due largely to component associations with onsets rather than with persistence, indirectly suggesting that the greatest focus of public health attention on CAs should be aimed at primary rather than secondary prevention.

Hippocampal Plasticity in Response to Exercise in Schizophrenia [Original Article]

Context Hippocampal volume is lower than expected in patients with schizophrenia; however, whether this represents a fixed deficit is uncertain. Exercise is a stimulus to hippocampal plasticity. Objective To determine whether hippocampal volume would increase with exercise in humans and whether this effect would be related to improved aerobic fitness. Design Randomized controlled study. Setting Patients attending a day hospital program or an outpatient clinic. Patients or Other Participants Male patients with chronic schizophrenia and matched healthy subjects. Interventions Aerobic exercise training (cycling) and playing table football (control group) for a period of 3 months. Main Outcome Measures Magnetic resonance imaging of the hippocampus. Secondary outcome measures were magnetic resonance spectroscopy, neuropsychological (Rey Auditory Verbal Learning Test, Corsi block-tapping test), and clinical (Positive and Negative Syndrome Scale) features. Results Following exercise training, relative hippocampal volume increased significantly in patients (12%) and healthy subjects (16%), with no change in the nonexercise group of patients (–1%). Changes in hippocampal volume in the exercise group were correlated with improvements in aerobic fitness measured by change in maximum oxygen consumption (r = 0.71; P = .003). In the schizophrenia exercise group (but not the controls), change in hippocampal volume was associated with a 35% increase in the N-acetylaspartate to creatine ratio in the hippocampus. Finally, improvement in test scores for short-term memory in the combined exercise and nonexercise schizophrenia group was correlated with change in hippocampal volume (r = 0.51; P < .05). Conclusion These results indicate that in both healthy subjects and patients with schizophrenia hippocampal volume is plastic in response to aerobic exercise.

Long-Chain {omega}-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial [Original Article]

Context The use of antipsychotic medication for the prevention of psychotic disorders is controversial. Long-chain -3 (omega-3) polyunsaturated fatty acids (PUFAs) may be beneficial in a range of psychiatric conditions, including schizophrenia. Given that -3 PUFAs are generally beneficial to health and without clinically relevant adverse effects, their preventive use in psychosis merits investigation. Objective To determine whether -3 PUFAs reduce the rate of progression to first-episode psychotic disorder in adolescents and young adults aged 13 to 25 years with subthreshold psychosis. Design Randomized, double-blind, placebo-controlled trial conducted between 2004 and 2007. Setting Psychosis detection unit of a large public hospital in Vienna, Austria. Participants Eighty-one individuals at ultra-high risk of psychotic disorder. Interventions A 12-week intervention period of 1.2-g/d -3 PUFA or placebo was followed by a 40-week monitoring period; the total study period was 12 months. Main Outcome Measures The primary outcome measure was transition to psychotic disorder. Secondary outcomes included symptomatic and functional changes. The ratio of -6 to -3 fatty acids in erythrocytes was used to index pretreatment vs posttreatment fatty acid composition. Results Seventy-six of 81 participants (93.8%) completed the intervention. By study's end (12 months), 2 of 41 individuals (4.9%) in the -3 group and 11 of 40 (27.5%) in the placebo group had transitioned to psychotic disorder (P = .007). The difference between the groups in the cumulative risk of progression to full-threshold psychosis was 22.6% (95% confidence interval, 4.8-40.4). -3 Polyunsaturated fatty acids also significantly reduced positive symptoms (P = .01), negative symptoms (P = .02), and general symptoms (P = .01) and improved functioning (P = .002) compared with placebo. The incidence of adverse effects did not differ between the treatment groups. Conclusions Long-chain -3 PUFAs reduce the risk of progression to psychotic disorder and may offer a safe and efficacious strategy for indicated prevention in young people with subthreshold psychotic states. Trial Registration clinicaltrials.gov Identifier: NCT00396643

Extracellular Matrix-Glial Abnormalities in the Amygdala and Entorhinal Cortex of Subjects Diagnosed With Schizophrenia [Original Article]

Context Chondroitin sulfate proteoglycans (CSPGs), a main component of the brain extracellular matrix, regulate developmental and adult neural functions that are highly relevant to the pathogenesis of schizophrenia. Such functions, together with marked expression of CSPGs in astrocytes within the normal human amygdala and evidence of a disruption of astrocytic functions in this disease, point to involvement of CSPG-glial interactions in schizophrenia. Hypothesis Chondroitin sulfate proteoglycan–related abnormalities involve glial cells and extracellular matrix pericellular aggregates (perineuronal nets) in the amygdala and entorhinal cortex of subjects with schizophrenia. Design Postmortem case-control study. Setting The Translational Neuroscience Laboratory at McLean Hospital, Harvard Medical School. Specimens were obtained from the Harvard Brain Tissue Resource Center at McLean Hospital. Participants Two separate cohorts of healthy control (n = 15; n = 10) and schizophrenic (n = 11; n = 10) subjects and a cohort of subjects with bipolar disorder (n = 11). Interventions Quantitative, immunocytological, and histological postmortem investigations. Main Outcome Measures Numerical densities of CSPG-positive glial cells and perineuronal nets, glial fibrillary acidic protein-positive astrocytes, and total numbers of parvalbumin-positive neurons in the deep amygdala nuclei and entorhinal cortex. Results In schizophrenia, massive increases in CSPG-positive glial cells were detected in the deep amygdala nuclei (419%-1162%) and entorhinal cortex (layer II; 480%-1560%). Perineuronal nets were reduced in the lateral nucleus of the amygdala and lateral entorhinal cortex (layer II). Numerical densities of glial fibrillary acidic protein-positive glial cells and total numbers of parvalbumin-positive neurons were unaltered. Changes in CSPG-positive elements were negligible in subjects with bipolar disorder. Conclusions Marked changes in functionally relevant molecules in schizophrenia point to a pivotal role for extracellular matrix–glial interactions in the pathogenesis of this disease. Disruption of these interactions, unsuspected thus far, may represent a unifying factor contributing to disturbances of neuronal migration, synaptic connectivity, and GABAergic, glutamatergic, and dopaminergic neurotransmission in schizophrenia. The lack of CSPG abnormalities in bipolar disorder points to a distinctive aspect of the pathophysiology of schizophrenia in key medial temporal lobe regions.

Neurocognitive Endophenotypes for Bipolar Disorder Identified in Multiplex Multigenerational Families [Original Article]

Context Although genetic influences on bipolar disorder are well established, localization of genes that predispose to the illness has proven difficult. Given that genes predisposing to bipolar disorder may be transmitted without expression of the categorical clinical phenotype, a strategy for identifying risk genes is to identify and map quantitative intermediate phenotypes or endophenotypes. Objective To adjudicate neurocognitive endophenotypes for bipolar disorder. Design All participants underwent diagnostic interviews and comprehensive neurocognitive evaluations. Neurocognitive measures found to be heritable were entered into analyses designed to determine which test results are impaired in affected individuals, are sensitive to the genetic liability for the illness, and are genetically correlated with affection status. Setting Central valley of Costa Rica; Mexico City, Mexico; and San Antonio, Texas. Participants Seven hundred nine Latino individuals participated in the study. Of these, 660 were members of extended pedigrees with at least 2 siblings diagnosed as having bipolar disorder (n = 230). The remaining subjects were community control subjects drawn from each site who did not have a personal or family history of bipolar disorder or schizophrenia. Main Outcome Measure Neurocognitive test performance. Results Two of the 22 neurocognitive variables were not significantly heritable and were excluded from subsequent analyses. Patients with bipolar disorder were impaired on 6 cognitive measures compared with nonrelated healthy controls. Nonbipolar first-degree relatives were impaired on 5 of these, and the following 3 tests were genetically correlated with affection status: Digit Symbol Coding Task, Object Delayed Response Task, and immediate facial memory. Conclusion This large-scale extended pedigree study of cognitive functioning in bipolar disorder identifies measures of processing speed, working memory, and declarative (facial) memory as candidate endophenotypes for bipolar disorder.

Limited Attentional Bias for Faces in Toddlers With Autism Spectrum Disorders [Original Article]

Context Toddlers with autism spectrum disorders (ASD) exhibit poor face recognition and atypical scanning patterns in response to faces. It is not clear if face-processing deficits are also expressed on an attentional level. Typical individuals require more effort to shift their attention from faces compared with other objects. This increased disengagement cost is thought to reflect deeper processing of these socially relevant stimuli. Objective To examine if attention disengagement from faces is atypical in the early stages of ASD. Design Attention disengagement was tested in a variation of the cued attention task in which participants were required to move their visual attention from face or nonface central fixation stimuli and make a reactive saccade to a peripheral target. The design involved diagnosis as a between-group factor and central fixation stimuli type as a within-group factor. Setting Participants were taken from a cohort of patients at a university-based specialized clinic or from a pool of subjects participating in a prospective study of social cognition in ASD. Participants Toddlers with ASD (mean age, 32 months [n = 42]) were compared with toddlers with nonautistic developmental delays (mean age, 29 months [n = 31]) and with typically developing toddlers (mean age, 29 months [n = 46]). Main Outcome Measure Saccadic reaction time. Results Developmentally delayed and typically developing toddlers had more difficulties disengaging visual attention from faces than toddlers with ASD. This effect was not present in response to nonfacial stimuli. These results suggest that toddlers with ASD are not captivated by faces to the same extent as toddlers without ASD and that this effect is not driven by a generalized impairment in disengagement of attention. Conclusion The results suggest that face-processing difficulties in toddlers with ASD involve disruption of an attentional mechanism that typically supports deeper processing of these highly socially relevant stimuli.

Escitalopram and Enhancement of Cognitive Recovery Following Stroke [Original Article]

Context Adjunctive restorative therapies administered during the first few months after stroke, the period with the greatest degree of spontaneous recovery, reduce the number of stroke patients with significant disability. Objective To examine the effect of escitalopram on cognitive outcome. We hypothesized that patients who received escitalopram would show improved performance in neuropsychological tests assessing memory and executive functions than patients who received placebo or underwent Problem Solving Therapy. Design Randomized trial. Setting Stroke center. Participants One hundred twenty-nine patients were treated within 3 months following stroke. The 12-month trial included 3 arms: a double-blind placebo-controlled comparison of escitalopram (n = 43) with placebo (n = 45), and a nonblinded arm of Problem Solving Therapy (n = 41). Outcome Measures Change in scores from baseline to the end of treatment for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Trail-Making, Controlled Oral Word Association, Wechsler Adult Intelligence Scale–III Similarities, and Stroop tests. Results We found a difference among the 3 treatment groups in change in RBANS total score (P < .01) and RBANS delayed memory score (P < .01). After adjusting for possible confounders, there was a significant effect of escitalopram treatment on the change in RBANS total score (P < .01, adjusted mean change in score: escitalopram group, 10.0; nonescitalopram group, 3.1) and the change in RBANS delayed memory score (P < .01, adjusted mean change in score: escitalopram group, 11.3; nonescitalopram group, 2.5). We did not observe treatment effects in other neuropsychological measures. Conclusions When compared with patients who received placebo or underwent Problem Solving Therapy, stroke patients who received escitalopram showed improvement in global cognitive functioning, specifically in verbal and visual memory functions. This beneficial effect of escitalopram was independent of its effect on depression. The utility of antidepressants in the process of poststroke recovery should be further investigated. Trial Registration clinicaltrials.gov Identifier: NCT00071643

Abnormalities of Visual Processing and Frontostriatal Systems in Body Dysmorphic Disorder [Original Article]

Context Body dysmorphic disorder (BDD) is a psychiatric disorder in which individuals are preoccupied with perceived defects in their appearance, often related to their face. Little is known about its pathophysiology, although early research provides evidence of abnormal visual processing. Objective To determine whether patients with BDD have abnormal patterns of brain activation when visually processing their own face with high, low, or normal spatial resolution. Design Case-control study. Setting A university hospital. Participants Seventeen right-handed medication-free subjects with BDD and 16 matched healthy control subjects. Intervention Functional magnetic resonance imaging while viewing photographs of face stimuli. Stimuli were neutral-expression photographs of the patient's own face and a familiar face (control stimuli) that were unaltered, altered to include only high spatial frequency (fine spatial resolution), or altered to include only low spatial frequency (low spatial resolution). Main Outcome Measure Blood oxygen level–dependent signal changes in the BDD and control groups during each stimulus type. Results Subjects with BDD showed relative hyperactivity in the left orbitofrontal cortex and bilateral head of the caudate for the unaltered own-face vs familiar-face condition. They showed relative hypoactivity in the left occipital cortex for the low spatial frequency faces. Differences in activity in frontostriatal systems but not visual cortex covaried with aversiveness ratings of the faces. Severity of BDD symptoms correlated with activity in frontostriatal systems and visual cortex. Conclusions These results suggest abnormalities in visual processing and frontostriatal systems in BDD. Hypoactivation in the occipital cortex for low spatial frequency faces may indicate either primary visual system abnormalities for configural face elements or top-down modulation of visual processing. Frontostriatal hyperactivity may be associated both with aversion and with symptoms of obsessive thoughts and compulsive behaviors.

Stigma, Hope, and Challenge in Psychiatry: Trainee Perspectives From Five Countries on Four Continents [EDITORIALS]

Psychotherapy Training for Residents: Reconciling Requirements With Evidence-Based, Competency-Focused Practice [RESEARCH ARTICLES]

OBJECTIVE: The Accreditation Council for Graduate Medical Education (ACGME) and the Royal College of Physicians and Surgeons of Canada (RCPSC) changed the training requirements in psychotherapy, moving toward evidence-based therapies and emphasizing competence and proficiency as outcomes of training. This article examines whether the therapies selected for training are evidence based and the authors review research concerning methods for training and assessment that effectively lead to competence in these psychotherapies. METHODS: The authors searched PsycINFO and PubMed for studies from 2000 to 2009 using the terms meta-analysis, meta-analyses, and psychotherapy combined with specific psychotherapies listed in the ACGME and RCPSC requirements to determine if high-level evidence supported the use of these therapies in patients with psychiatric disorders. A similar systematic search was carried out using the same search engines for all years with the terms psychotherapy, competence, training, evaluation, and therapist rating scales for the specific therapies selected by the ACGME and the RCPSC to determine if empirically validated therapist competency scales and specific teaching methods that enhance competence could be identified. RESULTS: Meta-analyses support the use of several psychotherapies in the treatment of patients with psychiatric disorders and specifically those selected for training. Empirically validated rating scales assess therapist competence in several therapies, and specific teaching methods enhance therapist skill. CONCLUSION: The Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada have incorporated evidence-based psychotherapies in their new guidelines. Evidence-based methods for assessing competence and for teaching psychotherapy are available and could be encouraged or required in the future.

Psychiatric Residents' Views of Quality of Psychotherapy Training and Psychotherapy Competencies: A Multisite Survey [RESEARCH ARTICLES]

OBJECTIVE: Few studies of residents’ attitudes toward psychotherapy training exist. The authors examined residents’ perceptions of the quality of their training, support for training, their own competence levels, and associations between self-perceived competence and perceptions of the training environment. METHODS: An anonymous, web-based questionnaire was distributed to residents at 15 U.S. training programs in 2006–2007. Likert-scaled items were used to evaluate attitudes regarding psychotherapy training and self-perceived competence in five modes of psychotherapy: brief, cognitive-behavioral, combined psychotherapy and psychopharmacology, psychodynamic, and supportive. RESULTS: Surveys were completed by 249 of 567 residents (43.9%). Over one-half agreed that their program provided high-quality psychotherapy training. Concerns about the adequacy of the time and resources provided by their programs were expressed by 28%. Although residents generally believed that their training directors supported psychotherapy training, approximately one-third did not believe that other key department leaders were supportive. Across years of training and modes of therapy, residents perceived their own competence in neutral to slightly positive terms, with self-perceived competence increasing with years of training. CONCLUSION: Given the current residency training requirements, these data provide a mixed picture about how residents experience psychotherapy training. Residency programs may need to reassess the quality and quantity of resources dedicated to psychotherapy training. Critical appraisal of support provided by key departmental leadership is also warranted.

The Role of Personal Therapy in Psychiatric Residency Training: A Survey of Psychiatry Training Directors [RESEARCH ARTICLES]

OBJECTIVE: The authors examine the current place of personal therapy for residents in U.S. training programs. METHODS: All U.S. training directors were provided an anonymous survey assessing current attitudes and practices with regard to personal therapy and training director perception of their residents’ use of therapy. RESULTS: Training directors generally believed that personal therapy is useful during training, but fewer than one-third of residents seek therapy during residency. Program characteristics associated with the use of personal therapy by residents included training director beliefs in the value of therapy to mitigate personal problems, active encouragement by the training director to seek therapy, programmatic supports to reduce the cost of therapy to residents, and geographic location. CONCLUSION: The proportion of residents seeking personal therapy is falling, despite training directors’ perceptions of the benefit of therapy to residents. This study identified practices promoting a culture in which residents seek therapy.

Using Media to Teach How Not to Do Psychotherapy [RESEARCH ARTICLES]

OBJECTIVE: This article describes how using media depictions of psychotherapy may help in teaching psychiatric residents. METHODS: Using the HBO series In Treatment as a model, the authors suggest how boundary transgressions and technical errors may inform residents about optimal psychotherapeutic approaches.RESULTS: The psychotherapy vignettes depicted in In Treatment show how errors in judgment may grow out of therapists’ good intentions. These errors can be understood and used constructively for teaching. CONCLUSION: With the growing interest in depicting psychotherapy on popular TV series, the use of these sessions avoids confidentiality problems and may be a useful adjunct for teaching psychotherapy.

A Neurosciences-in-Psychiatry Curriculum Project for Residents in Psychiatry [RESEARCH ARTICLES]

OBJECTIVE: The author describes a 20-session, student-centered course relating contemporary neuroscience to psychiatry for second-year psychiatric residents. METHODS: Twenty residents who took the course (2003–2007) completed pre- and postcourse surveys and were contacted for more remote follow-up regarding the course. RESULTS: Survey results are predominantly qualitative and positive. CONCLUSION: This course is intended to be an active, student-centered learning experience as one exploration of practice-based learning, and it also explores the use of various applications of emerging telecommunications and information technology as a further learning goal. The course may have particular relevance for training programs with a dearth of local expertise in neuroscience relevant to psychiatry.

Kubler-Ross [RESEARCH ARTICLES]

Geriatrics Education in Psychiatric Residencies: A National Survey of Program Directors [RESEARCH ARTICLES]

OBJECTIVE: The authors describe the current characteristics of geriatrics training within general psychiatry training programs. METHODS: In the fall of 2006, a survey was mailed and made available online to all U.S. psychiatric residency program directors (N=181). RESULTS: The response rate was 54% (n=97). Of the responding psychiatry programs, 96% (n=93) required a clinical experience in geriatrics, with a mean of 54.9 half days of required clinical training. The predominant training sites were inpatient geriatric psychiatry acute care units, ambulatory care experiences precepted by one or more geriatric psychiatrists, and outpatient geriatric psychiatry assessment centers. The mean number of physician faculty per residency program available to teach geriatrics was 2.8 full-time equivalents, and the mean number of physicians certified in geriatric psychiatry was 3.2 per program. Conflicting time demands with other curricula was ranked as the most significant barrier to expanding geriatrics training. CONCLUSION: Variability in the amount of time devoted to geriatrics training exists across general psychiatric residency programs. Some residents spend very little time in specific required geriatric psychiatry clinical experiences and have limited exposure to well-trained geriatric psychiatrists. Therefore, some psychiatrists who will take care of older patients in the future may be ill prepared to do so.

Terminating the Frame [RESEARCH ARTICLES]

Don't Leave Teaching to Chance: Learning Objectives for Psychodynamic Psychotherapy Supervision [BRIEF REPORTS]

OBJECTIVE: The way in which the competencies for psychodynamic psychotherapy specified by the Psychiatry Residency Review Committee of the Accreditation Council for Graduate Medical Education translate into the day-to-day work of individual supervision remains unstudied and unspecified. The authors hypothesized that despite the existence of competencies in psychodynamic psychotherapy, residents did not know what they should be learning in psychodynamic psychotherapy supervision. METHODS: Twenty-four psychiatric residents in PGYs 3 and 4 at Columbia University were asked to complete an anonymous course evaluation about their learning experience in psychodynamic psychotherapy supervision. The evaluation had eight items: seven yes/no questions and one open-ended question. RESULTS: Sixteen of 24 surveys were returned, a response rate of 66.6%. Of the residents who responded, eight said they did not know what they were supposed to be learning in psychodynamic psychotherapy supervision, nine had not discussed this with their supervisor, and six did not believe that their discussions in psychodynamic psychotherapy supervision correlated with didactic courses. CONCLUSION: These results support the need for specific learning objectives for psychodynamic psychotherapy supervision that can be communicated to both supervisors and supervisees to facilitate the process of learning and assessment.

Excuses [BRIEF REPORTS]

Adequacy of Psychiatric Training: A Singaporean Perspective [BRIEF REPORTS]

OBJECTIVE: The specialty training program for psychiatry in Singapore is transitioning to a seamless 5-year training program. It is timely to assess the perceived adequacy of current psychiatric specialty training. METHODS: An anonymous survey was sent to all psychiatry trainees and psychiatrists in the public sector to assess the current adequacy and perceived importance of 11 aspects of psychiatric specialist training. RESULTS: Forty-nine percent of those surveyed (54 of 110) replied. The current adequacy of training was rated lower than the perceived importance of training for all 11 aspects of training. Those aspects of training rated most important were disorder and diagnosis, pharmacological treatment, clinical interview, and treatment skills. Psychiatrists rated most aspects of training as being more important than did trainees except for cultural aspects, research, and basic neuroscience. Psychiatrists rated adequacy of training better than did trainees, except in the aspect of research. The difference between psychiatrists’ and trainees’ ratings for adequacy of psychotherapy treatment knowledge was significant (p<0.05). CONCLUSION: There were perceived deficiencies in all 11 aspects of training. Psychiatrists and trainees have different perceptions of adequacy and importance of training.

The Beautician [BRIEF REPORTS]

An Anonymous Survey of Psychosomatic Medicine Fellowship Directors Regarding Breaches of Contracts and a Proposal for Prevention [BRIEF REPORTS]

OBJECTIVE: The authors studied how often applicants accept positions at more than one program, or programs offer positions to applicants who have already signed contracts with other programs. METHODS: An anonymous survey was distributed to all psychosomatic medicine fellowship program directors. RESULTS: It is fairly common for applicants to sign contracts for fellowship positions and then back out of the contracts. Only one program reported ever knowingly offering a contract to an applicant who had accepted a position elsewhere. Programs are divided over whether there are extenuating circumstances under which it would be acceptable to offer a position to an applicant who has already signed a contract with another program. CONCLUSION: Guidelines for fellowship programs that do not use the National Resident Match Program can improve the recruitment process.

Supportive Psychotherapy: A Crash Course for Medical Students [RESOURCE]

Passing of the Renaissance Man and Woman [RESOURCE]

Views of Psychiatry: A Comparison Between Medical Students From Barcelona and Medellin [INTERNATIONAL EDUCATION REPORT]

The Unit [INTERNATIONAL EDUCATION REPORT]

Medical Students' Beliefs and Attitudes Toward Mental Illness: Effects of a Psychiatric Education [INTERNATIONAL EDUCATION REPORT]

Splitting [INTERNATIONAL EDUCATION REPORT]

Students' Attitudes Toward Psychiatry at Al-Hassa Medical College, Saudi Arabia [INTERNATIONAL EDUCATION REPORT]

Attitudes Towards Psychiatry: A Survey of Romanian Medical Residents [INTERNATIONAL EDUCATION REPORT]

Safety and Respectful Treatment of Medical Students and Residents [LETTERS]

Comparing Psychiatrists' and Primary Care Physicians' Knowledge of Nonpsychiatric Medicine [LETTERS]

Disclosure of Competing Interests [ANNOUNCEMENT]

Theory of mind in obsessive-compulsive disorder: Comparison with healthy controls.

Related Articles Theory of mind in obsessive-compulsive disorder: Comparison with healthy controls. Eur Psychiatry. 2009 Dec 22; Authors: Sayın A, Oral N, Utku C, Baysak E, Candansayar S AIM: Theory of mind (ToM) is the ability to represent one's own or another's mental states and has been found to be impaired in many psychiatric disorders. Our objective was to compare ToM abilities of patients with obsessive-compulsive disorder (OCD) with healthy controls and to investigate the relation between some illness features, other cognitive functions and ToM abilities of patients. METHOD: Thirty OCD patients and age, sex and education matched 30 healthy controls were compared according to their performances on ToM tasks (including first and second order false belief, hinting task and double-bluff task), verbal memory processes test, Weschler memory test (WMT) (logical memory, visual reproduction and digit span sub-tests), stroop test. RESULTS: Patients' performances were worse than healthy controls on all of the ToM tasks, but the results were significant for only for double-bluff task (t=-3.992, df=36.157, p<0.01). Performance on double-bluff task was significantly and positively correlated with visual reproduction-immediate recall (r=-0.411, p<0.05) and visual reproduction-delayed recall (r=0.478, p<0.05), hinting task was significantly and positively correlated with verbal memory (r=0.481, p<0.05). CONCLUSION: These results show "basic" ToM abilities of OCD patients are generally preserved, but they show significant reduction in their "advanced" ToM abilities, which seem to be related to their reduced memory capacities. The possible reasons for the relation between memory and ToM impairments, as well as the clinical significance of ToM deficits in OCD are discussed. PMID: 20034768 [PubMed - as supplied by publisher]