From MedPage Today:

  1. USPSTF Praised for Preeclampsia Guidance. When it comes to whether or not to treat women at high risk for preeclampsia with low-dose aspirin therapy, the U.S. Preventive Services Task Force (USPSTF) guidelines are spot on.
  2. Early Signs of Stroke Missed in Many Cases. Many strokes may be missed in emergency departments (EDs) in the days before the problems become obvious.

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Traditional psychodynamic therapy is often caricatured as endless, with a complacent therapist silently growing cobwebs, listening to a patient who never plans to leave.  This isn’t completely unfounded: There are therapeutic advantages to losing track of time, “swimming in the material,” and letting one’s therapeutic focus be broad.  The patient’s chief complaint, i.e., the ostensible reason for coming, often gives way to more troubling underlying conflicts and concerns that might never appear in ...

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Recently, I gave a lecture entitled, “Treating Depression in Primary Care,” at an annual conference for physician assistants.  I spent a good portion of the talk on the fundamentals that have been essential to me during my 15 years of practice.  When things go awry in mental health care, the majority of the time it is because one or more of these fundamental principles was neglected. My fear is ...

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For more than a decade I’ve taught a seminar in dynamic psychotherapy to psychiatry residents. One tricky issue that arises every year is the apparent choice between conducting a “supportive” psychotherapy, versus an “analytic” or “insight-oriented” one. I developed a sailing analogy to clarify this issue, and to teach an important point about it. Most patients appreciate emotionally comforting support. Many seek a therapist who will provide a listening ear, who ...

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One good thing about doing anything for three decades or longer is that you get to see cycles and repeated events, things that fail and things that work. I hope that over the last thirty years of learning about psychiatry and mental health (and yes, I am still learning and hope to acquire that one last little piece of knowledge on my deathbed) that I have paid attention to the ...

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Medical student Joyce Ho recently wrote an article in which she admitted to discomfort raising the topic of religion with patients.  As a “polarizing” issue that could make the doctor-patient relationship “more unprofessional,” Ms. Ho imagined that patients would fear playing into their doctors’ prejudices, particularly if the doctor were atheist, and that this fear would push some patients away from the inquiring doctor.  Despite her instructor’s recommendation to ask ...

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A patient I see for psychotherapy, without medications except for an occasional lorazepam (tranquilizer of the benzodiazepine class), told me his prior psychiatrist declared him grossly undermedicated in one of their early sessions, and had quickly prescribed two or three daily drugs for depression and anxiety.  He shared this story with a smile, as we’ve never discussed adding medication to his productive weekly sessions that focus on anxiety and interpersonal conflicts.  Indeed, ...

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As a psychiatrist, I was trained to begin the mental status examination and overall assessment of my patient as soon as I greeted them in the waiting room. Even now, three decades after finishing medical school, I follow almost the same sequence of actions in my day-to-day interactions with my patients that I did as a resident in training. Granted, there are now electronic medical records and I rarely come ...

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The page comes from the psychiatry intern on call. “There’s a situation with patient RB on the unit. Please advise.” We gather in the hall outside the patient’s room. There are already three -- no, four -- security guards standing several feet away with their arms folded. Backup. Ready. Ready for what? We whisper in hushed tones as the intern explains what happened. He was “acting out.” He was running through the ...

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Adults are the ones who are supposed to be stressed, not kids. Childhood is supposed to be the stress-free part of life, right? Well, maybe not. At least not for teens. According to a recently released survey from the American Psychological Association, teens are actually more stressed than their parents. Researchers surveyed 1950 adults and 1,018 teens last summer and asked them a whole bunch of questions about the stress in their lives, and how ...

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