Career Paths and Trends: How Does One Become a Leader in Psychiatric Administration? Implications for Residency Training.

In the changing landscape of healthcare the number of psychiatrists entering leadership positions has declined steadily over the years. One factor contributing to this appears to be lack of leadership training during residency training. International competency frameworks have addressed this and some programs, both national and international, have designed innovative curricula to provide didactic and experiential learning in administration during and after residency.

Informed Consent at Gunpoint: When Psychiatry Affects Gun Ownership.

As states take more steps to connect patients' gun ownership to their mental health, psychiatrists are being asked to provide mental health information after clinical interviews as well as after confiscation. This move into the patient-physician relationship raises new questions about how psychiatrists should obtain informed consent when interviews may result in reports to legal authorities. Consent warnings are already practiced more in the breach than in the observance and informed consent is imperfect at its best.

Chronotype and seasonality: morningness is associated with lower seasonal mood and behavior changes in the Old Order Amish.

Background: Several studies documented that lower scores on the Morningness-Eveningness Questionnaire (MEQ) are associated with a higher global seasonality of mood (GSS). As for the Modern Man artificial lighting predominantly extends evening activity and exposure to light, and as evening bright light phase is known to delay circadian rhythms, this chronic exposure could potentially lead to both lower Morningness as well as higher GSS. The aim of the study was to investigate if the MEQ-GSS relationship holds in the Old Order Amish of Lancaster County, PA, a population that does not use network electrical light.

The evaluation of sexual harassment litigants: reducing discrepancies in the diagnosis of posttraumatic stress disorder.

Relatively few targets of sexual harassment cope with the psychological sequelae of their experiences by engaging in litigation. Those who do are often subjected to forensic examination to evaluate their history of psychological distress or disorder and to determine whether such a condition could be reasonably attributed to the alleged harassment, as opposed to some other cause. An unbiased approach to such examinations is critical to all parties, as well as to the profession itself.

Encouraging legal help seeking for victims of intimate partner violence: the therapeutic effects of the civil protection order.

Civil protective orders (CPOs) are the most widely used justice system remedy for intimate partner violence (IPV), and were implemented to ensure safety and increase victim participation in the justice system. Limited data exists regarding the effectiveness of CPOs; however, theories of therapeutic jurisprudence argue that legal interventions in and of themselves can improve mental health outcomes. To test this hypothesis, we examined the effectiveness of having a CPO issued against one's abuser at improving the psychological sequelae of exposure to trauma.

Lithium toxicity and neurologic effects: probable neuroleptic malignant syndrome resulting from lithium toxicity.

Introduction. We present the case of a patient who developed lithium toxicity with normal therapeutic levels, as a result of pharmacokinetic interaction with Valsartan, and probable Neuroleptic Malignant Syndrome from the ensuing lithium toxicity. Case Presentation.

The recovery of religious and spiritual significance in American Psychiatry.

This paper reviews a body of data that identifies underlying influences that have contributed to an evolving change in American Psychiatry toward a more positive and receptive stance toward religion and spirituality over the past three decades. This development, surprising in light of the remedicalization of psychiatry and its predominantly neuro-biological orientation, is attributed to five foundational ideas that have helped to leverage this change. These are significance of culture, creative power of ritual, psychic function of belief, neuro-biology of spirituality, and relevance of recovery narratives.

Cloudy confidentiality: clinical and legal implications of cloud computing in health care.

The Internet has grown into a world of its own, and its ethereal space now offers capabilities that could aid physicians in their duties in numerous ways. In recent years software functions have moved from the individual's local hardware to a central server that operates from a remote location. This centralization is called cloud computing.

www.mydrugdealer.com: Ethics and legal implications of Internet-based access to substances of abuse.

The Internet has increasingly become an intrinsic part of everyday life, offering countless possibilities for education, services, recreation, and more. In fact, an entire virtual life within the digitalized World Wide Web is possible and common among many Internet users. Today's psychiatrists must therefore incorporate this dimension of human life into clinical practice, to achieve an adequate assessment of the tools and risks available to the patient.

Psychotropics without borders: ethics and legal implications of internet-based access to psychiatric medications.

Medical practitioners are revisiting many of the ethics and the legal implications surrounding the clinical frameworks within which we operate. In today's world, distinguishing between virtual and physical reality continues to be increasingly difficult. The physician may be found grappling with the decision of whether to continue to treat a patient who may be obtaining psychotropic medications through the Internet.

Why did this happen to me? Cognitive schema disruption and posttraumatic stress disorder in victims of sexual trauma.

Many trauma researchers have proposed cognitive schemas as a heuristic device to understand the elusive process of integrating traumatic events. We examined the schemas of a sample (N = 257) of female participants classified by exposure to sexual trauma, nonsexual trauma, and no trauma experience. Cognitive schema was assessed with the Traumatic Stress Institute Belief Scale.

Moving beyond ward based treatment: a public mental health hospital's transition to a treatment mall.

Saint Elizabeths Hospital in Washington D.C. implemented a treatment mall in 2002.

Midline abnormalities and psychopathology: how reliable is the midsagittal magnetic resonance "window" into the brain?

The argument is made that mensuration of midsagittal magnetic resonance (MR) images is plagued with methodological errors due to confusion of the midsagittal MR image and the mesial brain surface. Several examples are given to demonstrate the effects of slice thickness and orientation on the size and shape of mesial structures. The benefits of examining contiguous slices and the necessity of consulting coronal and transaxial cuts in mensuration efforts of midsagittal cuts are emphasized.

Diurnal variation in tardive dyskinesia.

Tardive dyskinesia (TD) is a common movement disorder that is associated with chronic neuroleptic exposure. To better characterize the clinical aspects of TD, we investigated the diurnal pattern of involuntary movements by blindly rating videotaped examinations of patients from the morning shortly after awakening and later in the same afternoon. In 10 patients, average TD ratings were worse in the afternoon than in the morning, especially in the case of limb-trunk dyskinesias.

Polyamines modulate the binding of GABAA-benzodiazepine receptor ligands in membranes from the rat forebrain.

The effects of spermine, spermidine and putrescine on the binding of the GABAA-benzodiazepine receptor complex were examined in the hippocampus and frontal cortex membranes of the rat. The results demonstrated modulatory effects of polyamines on the binding of diazepam and flunitrazepam but not on that of GABA, muscimol and Ro 15-1788. When membranes were prepared without detergent, the polyamines enhanced the binding of diazepam.

Haloperidol induced CSF protein variations in schizophrenic patients: as studied by two-dimensional electrophoresis.

High resolution two-dimensional electrophoresis of cerebrospinal fluid (CSF) from 10 schizophrenic patients demonstrated a 21% average difference in the number of proteins which could be detected in patients undergoing haloperidol therapy when compared with CSF from the same patients after withdrawal from neuroleptic treatment. Proteins affected were trace proteins, as we found no significant variation in either the total CSF protein content or the integrated protein density on each electrophoretic gel. Three mechanisms which might account for these observations are: (1) a small change in liver protein synthesis or degradation would have little if any visible effect on the concentration of major blood or CSF proteins, such as albumin, but it could significantly alter trace proteins, such as alpha 2-haptoglobin, since their concentrations are orders of magnitude less than that of the major proteins, (2) haloperidol might alter the blood-CSF protein filtration system which could affect the visibility of the trace proteins, and (3) proteins synthesized in the Central Nervous System (CNS) or enhanced in the CSF could be differentially affected by haloperidol.

Comparison of immunocytochemical and Holzer's methods for detection of acute and chronic gliosis in human postmortem material.

Immunocytochemical staining for glial fibrillary acidic protein (GFAP) allows more specific identification of astrocytes and their processes than classical histochemical techniques and has therefore recently been used by some investigators to quantify gliosis. However, although the immunocytochemical method is superior for delineation of reactive astrocytes, the examples presented here and previous work by others demonstrate that chronic fibrillary gliosis may be best detected by Holzer's method and not by GFAP immunocytochemistry. The authors' studies indicate that if, as in a recent study of gliosis in schizophrenia, computer-assisted densitometry is to be used to measure gliosis, the immunoperoxidase method may not be a sensitive technique to demonstrate glial changes in human postmortem material.

Cerebrospinal fluid protein variations in common to Alzheimer's disease and schizophrenia.

Analysis of silver stained two-dimensional (2D) gels of cerebrospinal fluid (CSF) from 27 patients with schizophrenia (SCZ) and 10 patients with Alzheimer's disease (AD) revealed an increase in the relative amount of a polypeptide of 18,000M(r) and isoelectric point of 6.5 when compared to the appropriate controls. This protein was identified by its electrophoretic characteristics and by immune analysis of Western blots as an isoform of alpha-2 haptoglobin, provisionally identified as alpha-2FS haptoglobin.

Polyamine uptake, binding and release in rat brain.

The uptake, binding and release of the polyamines, spermidine and spermine, and of their diamine precursor, putrescine, were examined in synaptosomal preparations from rat hippocampus. The specific and relatively high-affinity uptake by synaptosomes was found only with putrescine (Vmax = 21.6 pmol/mg protein per h; Km = 28.

Sodium pentosan polysulfate (PPS), an anti-HIV agent also exhibits synergism with AZT, lymphoproliferative activity, and virus enhancement.

Sodium pentosan polysulfate (PPS), a negatively charged polymer of beta-D-xylopyranose units, was evaluated for its anti-HIV effects in normal human peripheral mononuclear cells (PMNC) and its possible synergism with AZT. In the presence of 25 nM AZT, 2.0 micrograms/ml of PPS reduced HIV-1 replication 110-fold, compared with a 3.

Aging and stress-induced changes in choline and glutamate uptake in hippocampus and septum of two rat strains differing in longevity and reactivity to stressors.

Stress induced changes in neurochemical indices of neurotransmission are more pronounced in the septohippocampal cholinergic system of Wistar Kyoto rats, which are behaviorally more reactive to stressors and have a shorter life span, than in Brown Norway rats. Moreover, pronounced degeneration of septohippocampal cholinergic neurons occurs earlier in life in Wistar Kyoto rats. In the present study the high affinity synaptosomal uptakes of choline and glutamate were used as indices for cholinergic and glutamatergic systems respectively.

Expression of cell adhesion molecules from the L2/HNK-1 family in cerebellar isografts in mice.

The expression of cell adhesion molecules and glial fibrillary acid protein (GFAP) was examined in isografts of embryonic mouse cerebellum. Donor embryonic cerebella with the meninges removed were implanted into the lateral cerebral ventricles of adult host animals and examined after 2-6 weeks. Indirect immunofluorescence staining was performed on fresh frozen sections, using antibodies against the cell adhesion molecules L1, N-CAM, J1, myelin associated glycoprotein (MAG), and their shared L2/HNK-1 carbohydrate epitope, as well as GFAP.

Temporal lobe pathology in schizophrenia: a quantitative magnetic resonance imaging study.

Although numerous studies have confirmed the presence of larger cerebral ventricles in schizophrenia, the locus of tissue loss remains elusive. By analyzing magnetic resonance scans with computerized image analysis, the authors determined gray and white matter volumes in the temporal lobes and prefrontal regions of 17 patients with schizophrenia and 17 age- and sex-matched normal subjects. The volume of temporal lobe gray matter was 20% smaller in the patients than in the control subjects.

Lack of evidence for a role of T-cell-associated retroviruses as an etiology of schizophrenia.

The evidence that schizophrenia may involve infection by a virus (or viruses) has been indirect. The recent discovery, however, of the human retroviruses--human T-cell lymphoma-leukemia virus-I, and II (HTLV-I, -II) and human immunodeficiency virus (HIV)--now also known to affect the central nervous system (CNS), together with the development of new techniques in retrovirology, have made it possible to investigate more directly the role of this class of viruses as an etiology of schizophrenia. In our first effort to screen for the presence of a T-cell lymphotropic virus in schizophrenia, short-term tissue cultures of peripheral lymphocytes from 17 chronic schizophrenic patients and 10 normal controls were established.