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Members of the editorial board of Psychiatric Times and columnists have chosen a single article that each believes has particularly important clinical implications for psychiatrists. We invite you to listen [...]

On Saturday, March 6, Diana Chien became the fourth New York University student to commit suicide during the current academic year. However, it was the New York Post's decision to [...]

The article discusses the prevalence of pica, a condition in which an individual is compelled to consume non-food items like dirt, paper, and other substances, in adults. Topics discussed include a graphic that shows a case from 1929 in which a patient had 1,446 non-food items in his stomach, severe health consequences of eating non-food items such as toxic poisoning and nutritional deprivation, and an increase in number of hospitalizations from 1999 to 2009 by 93 percent due to pica.

An interview with lawyer James Barry Gottstein, co-founder and president of the Law Project for Psychiatric Rights and author of the book "The Zyprexa Papers," is presented. Topics covered include how he got involved in psychiatric legal advocacy, the ways in which companies misrepresent or misreport findings from clinical trials and the legal issue pertaining to the use of nonemergency involuntary medication.

The authors comment on the increase in eligibility criteria for physician-assisted suicide (PAS) or euthanasia under jurisdiction in the U.S. Topics discussed include the controversy surrounding PAS, arguments by proponents about PAS, the expansion of this eligibility criteria in other countries, the introduction of California Senate Bill 1196, and example of cases of PAS in Colorado.

The article calls for the future use of a standardized 12-hour lithium serum concentration notation in psychiatric research to secure the return of the therapeutic importance of lithium. It cautions about the detrimental consequences of the practice of omitting the notation for the standardized 12hour lithium concentration in scientific research and lithium toxicity case reports. It also cites reasons for the decline in lithium prescriptions for the treatment of patients with bipolar disorder.

The article discusses programs and policies addressing perinatal mental health crisis at the national, state, and local levels in the U.S. Initiatives at the population level aimed at improving the quality of care for perinatal individuals and their newborns and infants, the perinatal psychiatry access programs being implemented by states, and the benefits of the behavioral health model called collaborative care model (CoCM).

The article presents questions and answers related to adjunctive agents for suboptimal response to clozapine, combination of clozapine and a first-generation antipsychotic for treatment of neuroleptic malignant syndrome, management of the adverse effects of clozapine, and changes in the frequency of complete blood count monitoring and absolute neutrophil count.

An interview with psychiatrist Dr. Giovanni Fava, author of more than 500 scientific papers, is presented. Dr. Fava talks about the intellectual crisis being experienced by psychiatry, the use of the term "iatrogenic comorbidity" to refer to the lasting effects of previously administered treatments that negatively influence course, characteristics and responsiveness to treatment, and the findings of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study.

The article discusses the American College of Physicians' position paper, titled "American College of Physicians Ethical Guidance for Electronic Patient-Physician Communication: Aligning Expectations." Topics covered include in-person communication, security of electronic communications, and physician workload and well-being.

The article discusses a study published in "The New England Journal of Medicine" which assessed outcomes in patients who underwent carotid endarterectomy for asymptomatic disease. It was found that plastic polymers were detected in the removed plaques of 58 percent of patients and these patients had a higher composite risk of myocardial infarction, stroke, or all-cause death. Also mentioned is a separate study which investigated the effects of chemical additives in plastics.

The article examines why psychiatric diagnoses are neither circular nor uniformative nor lacking in explanatory value despite the absence of known pathophysiological processes as part of their diagnostic criteria. Topics include problems and inadequacies in DSM-5 psychiatric diagnostic categories, mistaken beliefs about the nature, scope, and purpose of the diagnostic categories, and diagnoses that embody so little descriptive or causal content as to be trivially nonexplanatory.

The article comments on a paper by Susan Dominus on the efficacy of psychotherapy. Topics mentioned include the lack of evidence about the role of antidepressants in the treatment of mental health, the author's concern about the uncertainty and disappointment about the effectiveness of psychotherapy, and the meta-analysis of the use of psychotherapy for depression, bipolar disorder, schizophrenia and functional somatic disorders.

The article discusses the reality of psychosis as detailed by Deborah Danner, a woman with self-described schizophrenia, shot to death by a New York City policeman. Topics discussed include the main strategies used by opponents of psychiatry when discussing schizophrenia and other forms of psychotic illness, a white paper by the British Psychological Society, "Understanding Psychosis and Schizophrenia," and Danner's essay "Living With Schizophrenia."

The article reviews the state of military psychiatry during the Vietnam War from 1964 to 1973. Topics discussed include the mental health challenges that arose in Vietnam, and the impact of the enemy's guerilla strategies and the rising opposition to the war at home as contributory factors to soldiers' behavioral disorders. Also mentioned is the action paper issued by the American Psychiatric Association commending military psychiatrists for their devotion in serving U.S. soldiers in Vietnam.

The article describes the social determinants of mental health. Topics discussed include categories of social determinants of mental health, the book "The Social Determinants of Mental Health" by Ruth S. Shim and colleagues, and position statement of the American Psychiatry Association (APA) on social determinants.

The article shares tips for managing multiple medication use. It discusses principles on prescribing medications to patients that include the potential of the prescriber to change the biology of their patient by the drugs they prescribe, the need to consider all drugs patients are taking in terms of their pharmacokinetics and pharmacodynamics, awareness of illicit drugs, over-the-counter drugs and nutraceuticals the patient is taking, and being disciplined when prescribing.

The article discusses the management of suicidal thoughts, behaviors and depression treatment. Topics covered include the universality of mental health problems and their occurrence among health professionals, updating the medical culture on more time with family, and acceptance of imperfection, and the need for evidence-based suicide prevention strategies, and support programs. Also noted are action options for individuals and physicians to address mental health.

The article discusses the steady increase of U.S. suicide rates since 2000 as of 2024. Topics covered include the multifactorial and complicated reasons like suicide method behind them, understanding such suicide causes as trauma, isolation and loneliness, and solutions like telepsychiatry and screening to address the increase of rates. Also noted is the importance of acknowledging how a patient's suicide affects the clinician.

An introduction to a series of articles on physician wellness published within the issue, including tips for preventing burnout among physicians, and another on the experience of a psychiatrist who embark on a change at work that led to improved wellness.

The article focuses on the health care reform suggested by the American College of Physicians (ACP) as outlined in its January 2020 policy paper.

An introduction to papers published within the issue is presented including one about schizophrenia, treatment-resistant depression, the role of mental health professionals in patients recovery, and the effectiveness of psychotherapy for older patients.

The article describes bleeding risk with serotonin reuptake inhibitors (SRI) in gastrointestinal (GI) bleeds, surgical/perioperative conditions, malignancy, and pregnancy, and in patients treated with hormonal therapies. Topics covered include broader recommendations for SRI use, the possible coprescription of an acid-suppressing agent with an SRI, and the insufficiency of data to consider SRI dose adjustment in certain patients. Also noted is the consideration of SRI withdrawal symptoms.

The article discusses the association of climate disruption with adverse childhood experiences (ACE). Topics covered include psychiatrist Lise Van Susteren's personal, professional, public, politics, and protest (5Ps) ways with which to engage the climate, the threat to mental health posed by climate change, and cases that emphasize the right of all persons to a clean and healthful environment. Also noted is psychiatry's unique role in helping the environment and the youth.

The article discusses the efficacy and safety of noninvasive brain stimulation (NIBS) techniques as potential treatments for substance use disorders (SUD). Among the NIBS approaches are transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Also cited is the approval by the U.S. Food and Drug Administration (FDA) of novel TMS systems for smoking cessation.

The article discusses bleeding risk with selective serotonin reuptake inhbitors (SSRI) with cardiovascular and cerebrovascular considerations. Topics covered include antidepressant-associated bleeding categorized by complication, heart failure and ventricular assist devices, and thromboembolic disease. Also noted is the influence of other factors on antidepressant-associated bleeding

The article discusses gender differences in attention-deficit/hyperactivity disorder (ADHD) and their clinical implications. Topics include indication that girls are half as likely as boys to receive this diagnosis, symptomatology and persistence, and observable comorbidities that affect members of each sex.

An interview with Diane Leary, PhD, a philosopher, disabled independent scholar, and 2023 Equality Now/Oped Project Fellow on Advancing the Rights of Women and Girls, is presented. Leary talks about her argument that medicine has misunderstood dualism, how confusion around dualism has led to an attitude of deliberate diagnostic vagueness that negatively impacted care of medically unexplained symptoms, and the problem in the case of medically unexplained symptoms.

The article offers information on plastics. It states that most plastics are fossil fuel or derived hydrocarbon polymers that are combined with chemical additives that instill desired physical properties. Also mentioned are industrial applications of plastics and properties of plastics that are critical to understanding their impacts on health.

The article discusses the Sequenced Treatment Alternatives to Relieve Depression (STAR*D), a prospective study that began with adults diagnosed with a current major depressive episode who were treated in participating psychiatric and primary care clinics. Topics include treatment interventions in the study, reason for reaanalyzing the STAR*D data, and novel agents that have entered the antidepressant armamentarium with approvals from the U.S. Food and Drug Administration (FDA) since 2006.

The article highlights the management of patients with treatment-resistant depression (TRD). Topics mentioned include the types of common clinical depression, a description of psychosocial stressors, the link of childhood trauma with molecular and neurobiological transformations, the presence of bipolarity in patients with TRD, and other symptoms of major depressive disorder.

The article presents a case study of a 74-year-old schizophrenic woman who had poor self-care, fatigue and suicidal ideation. Evaluation showed long-time restrictive eating patterns that led to low body weight, intense fear of gaining weight, and a comorbidity of anorexia nervosa. The woman was given a greater variety of foods in her diet over 4 weeks, and her ability to tolerate weight gain distress, and her body-mass index (BMI) increased. She was later medically admitted in a nursing home.

The article discusses the U.S. model minority myth which allowed selective immigration of Asians with high socioeconomic status that other ethnic minority groups resented. Topics covered include mentally ill people's attacks on Asian Americans, the structural inequities' beyond race or gender, that influence mental health and quality of life outcomes, and the lack of resources to care for needy groups. Also noted is the need to address historical and current issues of race and class.

The article focuses on the passage by the American Psychiatric Association (APA) of an action plan on the divestment of fossil fuels as part of its commitment to action on climate change. Topics covered include the divestment from fossil fuels companies as part of the preventive public health strategy of APA, the use of divestment to mitigate climate change that poses a threat to general and mental health, and divestment as a smart economic strategy.

The article describes the case of a 50-year old factory manager who requested disability from his psychiatrist after he was fired for initiating unapproved safety practices. Topics covered include his claim that he suffered post-traumatic stress disorder (PTSD) symptoms caused by the harassment he was subjected to and to wrongful termination, the problem with patient-defined disability, and the issues that psychiatrists need to consider when dealing with patients requesting disability.

An interview with Australian psychiatrist Niall McLaren is presented. When asked about his idea of natural dualism, McLaren explains that it is associated with philosopher David Chalmers and that his work offers biological mechanism by which a nonphysical mind emerges from the physical brain. He explains the computational model of the mind as an informational space he presented. He adds how mental disorders are defined in the biocognitive model.

An introduction to Special Report papers is presented which includes the interaction between pain and sleep disorders, opioids' exacerbation of pain, and posttraumatic stress disorder's (PTSD) possible role in developing chronic pain.

The article discusses new research about attention-deficit hyperactivity-disorder (ADHD). A review paper revealed that ADHD significantly impacts the costs of education and productivity. A 2009 study found a link between sudden unexplained death and the use of stimulants in children and adolescents with ADHD. It is said that ADHD has comorbidity with conditions that result in aggression and anger.

The article discusses strategies for building patient rapport including building a trusting relationship, praising the positive, not the negative, and setting appropriate boundaries.

The article suggests to have an appropriate presence on social media to attract new patients , market special skills, advocate for the field, and create or support another source of income.

The article offers information on the Clock-Drawing Test (CDT), one of the most innovative yet easy to administer tests for assessing brain dysfunction. Topics discussed include deficits that CDT can reveal, history of the CDT, and information on administering the CDT. Also mentioned is the literature on the CDT which has consistently supported its use as a cognitive screening tool.

The article offers guidance to help primary care teams provide culturally appropriate care for diverse patients. It presents the case of a 42-year old African American who shows psychotic disorder symptoms. It discusses the effect of the patient's intersectionality on his experience of the health care system, the need for the primary care team to balance the ethical dilemma of providing care and personal safety, and sociocultural differences within interpersonal interactions.

The article considers double bind communication as a representative feature or characteristic pattern in patients with borderline personality disorder (BPD). It cautions about the tendency of double binds to result to confusion, frustration and a sense of losing mind. It identifies variations of double binds including the Be Spontaneous paradox and covert contract. The relevance of spontaneous communication patterns to psychotherapy and the importance of therapeutic intervention are discussed.

The article discusses the adoption of health information technology (HIT) in psychiatric practice. HIT has the potential to improve the quality and efficiency of psychiatric services. The factors to consider when choosing the right technology for a psychiatric practice are described. Also included are instructions for implementing HIT.

The article discusses various studies on adolescent and child psychiatry. Topics covered include the treatment of children diagnosed with depression, the risk of tics associated with psychostimulant use in randomized trials and the prevalence of psychiatric disorders in Danish children. Also mentioned is the effectiveness of psychosocial interventions for anxiety in children and adolescents with autism spectrum disorder.

The article discusses U.S. physicians' need to help address chronic hunger and its effects in 2022. Topics covered include the American College of Physicians' (ACP) 6 recommendations to tackle food insecurity, and the latter's effects on a person's physical, cognitive, and mental health, and patients' belief that screening for food insecurity contributes to improved care and being understood better. Also noted are ACP nonclinical approaches for physicians to help tackle the problem.

The author discusses the effect of some traumatic events on certain populations. He reflects on the trauma suffered by his grandfather when he served as a medic in the American Expeditionary Forces during World War I. He also remembers the confusion, helplessness and disbelief when airplanes crashed into the World Trade Center twin buildings on September 11, 2001.

In the article, the author discusses issues in the practice of medicine, particularly the importance of medical conferences, peer-reviewed papers, and continuing medical education (CME) in advancing one's medical specialty. Also cited are the journal's World CME Conference to be held in September-October 2021, and how the COVID-19 pandemic disrupted the practice of psychiatry.