Search

Examines the psychiatric ramifications of human hand transplantation. Technical issues of the surgery; Discussion on the psychology of the hand; Clinical and theoretical considerations of the surgery.

Discusses the roles of the psychiatrist on the transplant team, beginning with the transplantation psychiatry consultation. Informed consent; History of present illness; Psychiatric history; Family psychiatric history; Medical history; Social history and support system; Mental status examination; Standardized instruments for psychosocial assessment.

Discusses several issues dealing with the practice of psychiatry in the United States. Psychiatry's working relationship with other mental health professions; Role of minorities in psychiatry; Financial issues on the recruitment of new psychiatrists.

A letter to the editor is presented discussing the authors' work developing a computer-based clinical simulation for psychiatry education.

A comprehensive review describes the benefits and risks of the combination of electroconvulsive therapy (ECT) and antipsychotic agents for patients with psychotic disorders. For some patients, combined treatment may lead to greater rates of response or more rapid improvement than with either therapy alone. Except for reserpine, combining neuroleptics with ECT is safe, but some precautions are suggested. The mechanism of interaction, effect on seizure threshold, the use of ECT for neuroleptic associated motor effects, and additional anesthesia considerations are discussed.

Opinions differ regarding the risks and benefits of the concurrent use of antipsychotic medication and ECT. A case example is presented of the safe and effective concurrent use of ECT and the newly available neuroleptic clozapine in a young patient with schizoaffective disorder, bipolar type. The patient's pulse did climb as high as 170-180 beats/min during a few of the seizures. More experience is needed with the combined use of clozapine and ECT.