From MedPage Today:

  1. Blame LABA Risks in Asthma on Gene Variants? Rare genetic variants may explain the equally uncommon but life-threatening adverse events seen with long-acting beta agonist (LABA) drugs in asthma.
  2. Psych Bed Shortage Threatens Public Safety. Last month, Austin Deeds, son of Virginia state Sen. Creigh Deeds, left a Virginia hospital emergency room, went home, stabbed his father, and then killed himself.

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A frequent response to those contemplating suicide is to remember friends and loved ones, how much one is needed and how much one would be missed. Some people have a sense this statement is true and that the depressive emotions are inaccurate, so seeking therapy, medication, or riding out the episode will result in returning to whatever emotional mode is typical. Others don't believe this sentiment, and they potentially live ...

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In 2007, I wrote a post called "Why Shrinks Don't Take Insurance."  The post is a bit dated, the CPT codes have changed since then, and the reasons to not take insurance have increased.  Many other doctors don't take insurance now, though psychiatry remains the number one specialty where doctors don't participate in health insurance plans.  This is an updated version of that same post. Many psychiatrists in private practice don't ...

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It was the first time I had every flunked a test. My fragile ego was shattered. It was my first year at University of California, San Diego School of Medicine, one of the most difficult to enter. I failed my pharmacology test, not because I was stupid, not because it was difficult, but because I was clinically depressed. A dark cloud covered my head and I could not see. Much of my ...

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I recently read an article in the New York Times titled "When Doctors ‘Google’ Their Patients," which details one physician’s thoughts on whether or not doctors should look up their patients on the Internet. What struck me was the fact that despite growing up with the Internet and being able to find information about practically anyone using Facebook, LinkedIn, Google, or Instagram,  I have never once been tempted to find out ...

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Every once in a while a brilliant investigative journalist can get us back on track when we have been led badly astray. I hope that a recent New York Times front page story, "The Selling of Attention Deficit Disorder," by Alan Schwarz will have that kind of special societal impact. Schwartz has previously written a series of accurate and hard-hitting articles exposing the over-diagnosis of ADHD and the consequent careless and excessive ...

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I’m coming out, but it isn’t what you’re thinking.  I’m writing this to finish answering a question that I was asked 25 years ago by an attending physician.  He was a Scotsman with a ruddy complexion and it was early in my third year of medical school.  I had been up since 4am rounding on patients and then assisting on a general surgery case. Answering the esoteric questions the Scotsman posed had ...

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While on my inpatient psychiatry rotation, I had the opportunity to work with an adolescent female with a troubled past and a significant history of psychiatric illness. It was through coloring that her barriers broke down and we were able to establish a safe space for difficult conversations. She was safely discharged two weeks after her suicide attempt. As she left, she gave me a hug and handed me this: Through our patients we find ourselves
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I’ve been skeptical of the trend of “holding back” children with late birthdays. These are kids, usually born in the summer, who are just a few months short of the next grade cut-off. Some parents wonder whether it would be wise to hold them back a few months, so they end up one of the oldest (rather than youngest) kids in their class. This might seem to confer an advantage ...

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A colleague of mine recently pointed out a study by the Center for Health Care Strategies (CHCS) about mental health care for children. Among their findings was this: Almost 50 percent of children enrolled in Medicaid who are prescribed psychotropic medications receive no identifiable behavioral health treatment. This is a disturbing, though not surprising, statistic given that these medications are commonly prescribed by primary care clinicians. Children living in poverty often experience greater environmental stress ...

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