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Welcome to the fifth e-issue of the Residents’ Journal, an e-publication to serve as a forum for your articles and a gateway to features of the American Journal of Psychiatry. This month we feature three articles from the current American Journal of Psychiatry that we feel might have value to you in your training, and discuss how to approach the Results and Discussion sections of original articles.
You are welcome to forward this e-mail to your colleagues, who can register to receive their own copy. Comments, questions, and suggestions -- along with any difficulties in accessing the full-text articles -- can be directed to Lisa Devine, Staff Editor, who is responsible for the publication.
| The American Journal of Psychiatry |
| Residents’ Journal |
The Residents’ Journal is an exclusive forum to share your ideas and experiences in training, clinical practice, research, and careers with your colleagues. This month’s Residents’ Journal consists of two original contributions from your peers. Dr. Katherine Maloy discusses how to improve a resident’s sense of effectiveness when treating schizophrenia, and Dr. Andrew Kaufman discusses the use of law enforcement in the emergency transportation of mentally ill
patients. There is also a new column from Editors Robert Freedman, M.D., and Susan Schultz, M.D.
The Residents’ Journal is now also available online, at the American Journal of Psychiatry’s home page. You may either view the attachment or click on the link above to access the publication. Alternatively, you may visit the AJP website and click on the Table of Contents (next to the cover image), and
choose “In This Issue.” There you will find a link to the “Residents’ Journal.”
If you would like to submit a short piece for publication in the Residents’ Journal, please visit our website at http://appi.manuscriptcentral.com/. Once there you will need to create an user account if you do not already have one. Please designate your submissions as “Resident Journal,” and please keep to under 500 words. Your participation will ensure the continued success of this e-publication.
Special Article: Psychoanalytic Psychotherapy for Panic Disorder
This month we direct you to a
special article that is the subject of a discussion by Editors Robert Freedman, M.D. and Susan Schultz, M.D. in this month’s Editors’ Column:
Milrod B, Leon AC, Busch F, Rudden M, Schwalberg M, Clarkin J, Aronson A, Singer M, Turchin W, Klass ET, Graf E, Teres JJ, Shear MK: A Randomized Controlled Clinical Trial of Psychoanalytic Psychotherapy for Panic Disorder. Am J Psychiatry 2007; 164:265-272
The Editors’ Column appears in the attachment. Also, an editorial by Dr. Arthur Rifkin on randomized controlled trials and psychotherapy research appeared in the January 2007 issue.
Journal Club Kit: Psychiatric Disorders and Obesity
This month’s featured article is:
Kalarchian MA, Marcus MD, Levine MD, Courcoulas AP, Pilkonis PA, Ringham RM, Soulakova JN, Weissfeld LA, Rofey DL: Psychiatric Disorders Among Bariatric Surgery Candidates: Relationship to Obesity and Functional Health Status. Am J Psychiatry 2007; 164:328-334
Kalarchian et al. document current and lifetime psychiatric disorders among candidates for weight loss surgery and examine the relationship of psychopathology to severity of obesity and functional health status. This report from the authors is part of a
larger, prospective study of behavioral and psychosocial factors in bariatric surgery.
Recent surveys indicate that more than 80% of programs require preoperative mental health evaluations for bariatric surgery, yet the prevalence and clinical significance of psychiatric disorders in this group are not well documented. Preliminary evidence suggests that bariatric surgery patients may have high rates of psychopathology by virtue of the severe obesity and related comorbid medical conditions that lead them to seek treatment.
In their study, Kalarchian et al. find that individuals seeking treatment of obesity report more psychopathology than do obese individuals in the community. Studies to determine causal pathways between obesity and specific disorders, as well as mediators and moderators of the relationships between psychiatric disorder and obesity, are clearly needed. In light of the sharply increasing number of patients who opt for surgical treatment of obesity, targeted interventions to help patients achieve optimal surgery preparation and outcome will have a strong public health impact.
Discussion Questions:
1. Why did the 1991 NIH Consensus Development Conference Panel for Gastrointestinal Surgery for Severe Obesity suggest that the pre-surgical evaluation include psychiatric expertise?
2. What is the most common class of psychiatric disorder diagnosed upon evaluation prior to weight loss surgery?
3. What are axis I psychiatric disorders associated with among candidates for weight loss surgery?
Treatment in Psychiatry: Alcohol Use and Anxiety
This month’s featured article is:
Brady KT, Tolliver BK, Verduin ML: Alcohol Use and Anxiety: Diagnostic and Management Issues. Am J Psychiatry 2007; 164:217-221
Brady et al. describe the case of a 40-year old woman with complaints of anxiety and sleep disturbances who had begun drinking wine at night to help her sleep. Gradually she increased her alcohol intake to 2 to 3 glasses per night, sometimes drinking a whole 32-ounce bottle by herself. This was worrying to the patient, as she had a family history of alcoholism.
Alcohol use disorders are among the most common psychiatric disorders, yet they are underdiagnosed and often go untreated. There are a number of reasons why a physician might fail to make a diagnosis of an alcohol use disorder. Denial
is a core feature of the illness, so individuals with an alcohol problem often have limited insight into the impact their consumption has on their life and well-being. The social stigma attached to alcohol use disorders may also make it difficult for patients to fully disclose the extent and consequences of their alcohol use. This is particularly problematic for women, and women who have an alcohol problem are less likely than men to be diagnosed.
The authors discuss a number of psychotherapeutic approaches that are effective in treating alcohol use disorders. In a multisite trial supported by the National Institute on Alcohol Abuse and Alcoholism, cognitive behavior therapy, 12-step
facilitation, and brief motivational therapy were all found to be equally effective in improving alcohol-related outcomes during the 1-year follow-up. The authors also include a review of drug treatments for anxiety disorders and for alcohol withdrawal.
Discussion Questions:
1. What would be an appropriate guideline for diagnosing co-occurring anxiety and alcohol use disorders?
2. How would you describe the current understanding of pharmacotherapy of comorbid anxiety and alcohol use disorders?
3. According to epidemiologic evidence, which anxiety disorder is typically antecedent to alcohol use disorders in comorbid populations?
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