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Mental Health Care...For Free? - WYPR

Maryland Psychiatry - 23. December 2013 - 6:08

Mental Health Care...For Free?
WYPR
The project began in 1991 when Maryland psychologists, clinical workers, and psychiatrists were trying to collect data to show mental health care was out of reach for many people. The data they collected soon became the basis of the project's grants.

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Cymbalta Goes Generic

Shrink Rap - 21. December 2013 - 8:00

On December 11th, the FDA approved the use of generic Cymbalta.  The generic version, Duloxetine, delayed release,  became available in the USA four days ago.

Generics generally work just fine and they cost less.  Now and again, some people have side effects or feel the generic is not as effective effective, and for those individuals, it makes sense to remain on the name brand medication.  Generics cost less and the active ingredients are the same.  Oh, but there was a little issue with the efficacy of one pharmaceutical company's preparation of Wellbutrin, XL, 300mg.  See the In The Pipeline discussion of the problem in this blog post, "The Generic Wellbutrin: Whose Fault is It?"

So, generic Cymbalta -- is it okay to take this today?  I have some thoughts.

 I imagine it's probably fine and it's probably cheaper.  In fact, I called one pharmacy, and their out-of-pocket price  for a single 30mg tablet ss $11.73 for Cymbalta, and $8.44 for generic Duloxetine.  So the cost is less, but we're still talking about a very expensive medication, even in generic form.   It's also the holiday season: stress runs high and moods run low.  I imagine it's fine, but for any given person, there is the question with any medication switch as to whether that person might be the person to have side effects or experience less efficacy.

So just to consider :
  --What happens to this person during an episode of depression?  If prior episodes of depression required hospitalization, it might be worth waiting a little and seeing how others who have had milder episodes of depression respond to the generic.
 -- Physicians won't be consulted first, the pharmacy simply makes the substitution.
 -- If there is a problem, the psychiatrist may be away for the holidays and a covering doctor may have to be consulted.
-- It's a preparation of the medication that US physicians have no experience with.  The generic form has been available in other countries.

Medications change to generic all the time, including many antidepressants.  The cost drops and the medication becomes more accessible.  Generics work fine, and I personally have no qualms about taking them.  So I'll leave this as my take away message: just beware that this change has occurred and prescribers may not know about it.  If patients call with problems, it may be worth asking if their medication was changed to a generic, and patients who have problems may want to mention to their doctors that the medication was changed. 

   ----- Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail dot com Our book is out now.

For the Mentally Ill, Finding Treatment Grows Harder - Wall Street Journal

Maryland Psychiatry - 20. December 2013 - 23:00

For the Mentally Ill, Finding Treatment Grows Harder
Wall Street Journal
LEONARDTOWN, Md.—To the outside world, it came across as mood swings and anger. But Regina Cullison would later be told by psychiatrists she struggled with depression and anxiety—and that she needed help. And that is where her trouble began and ...

and more »
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Psychiatry 2013 and DSM-5 - Psychiatric Times

Latest Psychiatry News - 19. December 2013 - 10:35

Psychiatry 2013 and DSM-5
Psychiatric Times
Arguably, one of the most important developments in psychiatry in 2013 was the release of DSM-5 in May. This was the first substantial revision to DSM since the introduction of DSM-IV in 1994. DSM-5 is the culmination of several years of meetings of ...

and more »
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Seizure Drug Shows Promise As Cocaine-Addiction Treatment - Psychiatric News

Maryland Psychiatry - 19. December 2013 - 10:05

Seizure Drug Shows Promise As Cocaine-Addiction Treatment
Psychiatric News
“Finding a safe and effective medication (or vaccine) for the treatment of cocaine use disorder has been the holy grail of our field for decades,” Petros Levounis, M.D., chair of psychiatry at Rutgers New Jersey Medical School and an addiction ...

and more »
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Book Review: The Drugs Don't Work? Antipsychotics, Big Pharma, and Psychiatry - PLoS Blogs (blog)

Latest Psychiatry News - 18. December 2013 - 18:04

Book Review: The Drugs Don't Work? Antipsychotics, Big Pharma, and Psychiatry
PLoS Blogs (blog)
The first antipsychotic drugs were introduced to treat psychiatric patients in the 1950s, and since that time, they have become the principal pharmacological treatment for a wide range of severe psychiatric illnesses. These include schizophrenia, and ...

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Psychiatry Practice Changers: 2013 - Medscape

Latest Psychiatry News - 18. December 2013 - 12:17

Psychiatry Practice Changers: 2013
Medscape
With new approvals, advances in interventional psychiatry, and an evolving appreciation of optimal psychotropic prescribing, psychiatrists had a lot to keep up with in 2013. Based primarily on Medscape Medical News coverage and input from our expert ...
Murdering justice with psychiatryTrinidad & Tobago Express

all 2 news articles »
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Can "Niches in Inpatient Psychiatry" Redeem the Brattleboro Retreat? - Seven Days

Latest Psychiatry News - 18. December 2013 - 10:13

Seven Days

Can "Niches in Inpatient Psychiatry" Redeem the Brattleboro Retreat?
Seven Days
“The more we study LGBT health, the more we recognize that disparities do exist in accessing care,” says Karl Jeffries, Paige's psychiatrist and a specialist in treating gender-variant youth and adults. “One of the things we focus on is, what services ...

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PsychiatryOnline.com Book of the Month for May: Traumatic Dissociation: Neurobiology and Treatment

Psychiatry Online - 6. April 2010 - 20:45
May brings Traumatic Dissociation: Neurobiology and Treatment, edited by Eric Vermetten, M.D., Ph.D., Martin J. Dorahy, Ph.D., and David Spiegel, M.D.

Traumatic Dissociation: Neurobiology and Treatment offers an advanced introduction to this symptom, process, and pattern of personality organization seen in several trauma-related disorders, including acute stress disorder, posttraumatic stress disorder (PTSD), and the dissociative disorders. Our understanding of traumatic dissociation has recently been advanced by neuroimaging technology, empirically-based investigation, and an acknowledgment of its importance in psychopathology. The authors of this volume tie these findings together, tracking the condition from its earliest historical conceptualization to its most recent neurobiological understanding to provide even greater insight into traumatic dissociation and its treatment.

Bringing together for the first time theoretical, cognitive, and neurobiological perspectives on traumatic dissociation, this volume is designed to provide both empirical and therapeutic insights by drawing on the work of many of the main contributors to the field. Opening chapters examine historical, conceptual, and theoretical issues and how other fields, such as cognitive psychology, have been applied to the study of traumatic dissociation. The following section focuses specifically on how neurobiological investigations have deepened our understanding of dissociation and concluding chapters explore issues pertinent to the assessment and treatment of traumatic dissociation. The interacting effects of traumatic experience, developmental history, neurobiological function, and specific vulnerabilities to dissociative processes that underlie the occurrence of traumatic dissociation are among some of the key issues covered. The book's significant contributions include
* A review of cognitive experimental findings on attention and memory functioning in dissociative identity disorder
* An appreciation of how the literature on hypnosis provides a greater understanding of perceptual processing and traumatic stress
* Ascertaining symptoms of dissociation in a military setting and in other situations of extreme stress
* An outline of key issues for planning assessment of traumatic dissociation, including a critique of its primary empirically supported standardized measures
* An examination of the association between child abuse or neglect and the development of eating disorders, suggesting ways to therapeutically deal with negative body experience to reduce events that trigger dissociation
* A description of neuroendocrine alterations associated with stress, pointing toward a better understanding of the developmental effects of deprivation and trauma on PTSD and dissociation
* A review of the relation of attachment and dissociation
* A discussion of new research findings in the neuroimaging of dissociation and a link between cerebellar functioning and specific peritraumatic experiences

Useful as a clinical reference or as ancillary textbook, Traumatic Dissociation reorganizes phenomenological observations that have been overlooked, misunderstood, or neglected in traditional training. The research and clinical experience described here will provide the basis for further clinical and theoretical formulations of traumatic dissociation and will advance empirical examination and treatment of the phenomenon.

You can access the Book of the Month from the home page, at PsychiatryOnline.com. You'll have access to Traumatic Dissociation: Neurobiology and Treatment as a PDF download for the month of May.

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PsychiatryOnline.com Book of the Month for April: Recognition and Prevention of Major Mental and Substance Use Disorders

Psychiatry Online - 6. April 2010 - 20:45
April brings Recognition and Prevention of Major Mental and Substance Use Disorders edited by Ming T. Tsuang, M.D., Ph.D., D.Sc., William S. Stone, Ph.D., and Michael J. Lyons, Ph.D.

Recognizing that favorable clinical outcomes are associated with earlier initiation of treatment—and even more ideally with prevention—this volume addresses the current status of early intervention in, and prevention of, major mental and substance use disorders. A team of distinguished participants addresses this problem at many levels—from the DNA molecule to public policy—in order to show how prevention efforts should be informed by a better understanding of etiology and by a knowledge of indicators of vulnerability.

In considering the current standing of etiological knowledge, Recognition and Prevention of Major Mental and Substance Use Disorders addresses issues that are critical precursors to the prevention of mental disorders and offers an understanding of factors that contribute to the disorders' development. The contributors review genetic methodologies and current findings in mental disorders, with an emphasis on schizophrenia, and then show how biological and psychosocial environmental variables may affect vulnerability. Chapters devoted specifically to lessons in prevention drawn from recent research into schizophrenia discuss the implications of prodromal studies and relationships between stress, critical periods, and the development of the disorder. The book includes contributions from NIH representatives on how basic scientific understanding of mental disorders can be translated into public policy. It also features chapters that describe cutting-edge projects in prevention research for Alzheimer's disease, drug dependence, antisocial behavior, and posttraumatic stress disorder—each providing compelling accounts of how existing knowledge can be adapted to promising prevention efforts. Among the volume's contributions:
* New data on the role of substance abuse—particularly marijuana and psychostimulants—in increasing vulnerability to schizophrenia
* Review of vulnerability factors for several relevant disorders, examining stress and its concomitant psychobiological responses and the contribution of cognitive factors to vulnerability to depression
* Intriguing approach for translating successful treatment methods for schizophrenia into efforts to prevent the transition from the prodrome of the disorder to the full-blown illness
* Program for prevention of antisocial behavior that can be implemented as early as the first grade
* Secondary prevention efforts for posttraumatic stress disorder, with a focus on pharmacological interventions

Each chapter reviews clinical implications of the research presented, contributing to a volume that will benefit clinicians and researchers who share the goal of preventing these debilitating conditions. This multidimensional, interdisciplinary work represents a major step toward cutting the social costs of these disorders—and, more important, their untold cost in human suffering.

You can access the Book of the Month from the home page, at PsychiatryOnline.com. You'll have access to Recognition and Prevention of Major Mental and Substance Use Disorders as a PDF download for the month of April.

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