Quality psychiatric care is needed
China Daily article mirrored on Xinhua
Monday, July 5, 2010
Sunday, July 4, 2010
China Daily Op-ed: Quality psychiatric care is needed - not only in China
Cross-posted from Chinadaily.com July 5, 2010:
http://www.chinadaily.com.cn/opinion/2010-07/05/content_10056660.htm
Quality psychiatric care is needed
Op-Ed By Dr. Maurice Preter (China Daily)
Updated: 2010-07-05 08:00
The recent spate of attacks on schoolchildren and the workers' suicides at the Foxconn factory in Shenzhen have again highlighted China's urgent need to balance economic progress with care for those left behind, and unable to cope with, the lightning speed of development.
Sustainable development is an avowed goal of Chinese government policy, and from a medical-psychological perspective, accessible, quality general medical and psychiatric care is a fundamental part of long-term, ecologically minded, peaceful societal progress.
However, it is an open secret that the medical profession in China is in disarray and rather ill-equipped to contribute to the solution of China's larger societal problems. Chinese physicians are overworked. They routinely see several dozen, if not a hundred patients a day, including those in urgent need of expert mental health treatment.
They are forced to accept absurdly low salaries and are consequently, generally disrespected. Pharmaceutical sales productivity incentives imposed by hospital administrations and by the wish to supplement meager earnings lead to a medical assembly line mentality that short-changes patients and frustrates doctors.
It comes as no surprise that, according to data cited in this newspaper (China Daily, March 25, 2010: "Doctors at receiving end in medical reform"), there are high levels of stress and depression among Chinese doctors.
Coincidentally or not, this year's most murderous school attack was perpetrated by a supposedly mentally ill physician.
This situation is unlikely to attract the needed numbers of highly intelligent and motivated students to the practice of medicine. This in turn stymies the development of quality medical care, and the future acquisition and transmission of clinical knowledge. However, the recent violent events are a cruel reminder that China must make the rational delivery of compassionate, sophisticated medical-psychiatric care an absolute priority.
Keeping in mind that for the foreseeable future, the majority of mentally ill and emotionally distressed patients in China will continue to receive their care from general (non-specialist) doctors, what is the current situation in my own field of practice?
Chinese patients seeking expert help for mental distress will often receive care from physicians educated without any knowledge of available non-drug based treatment options, such as psychodynamic psychotherapy, group therapy and other types of behavioral interventions.
While in the West the set ways of medicine, and especially psychiatric medicine, are increasingly coming under critical scrutiny, most Chinese psychiatrists limit themselves to simplistic, obsolete interpretations of Western biomedical models that de-emphasize empathic listening.However, quality medical care, and especially mental health care, begins with a well-trained and experienced physician who is able to create a therapeutic alliance with a suffering and often frightened, and ashamed patient.
By contrast, the lack of time spent with an individual patient (when there are countless individuals waiting to be seen), combined with the economic reality of multiplying one's salary by writing huge numbers of prescriptions puts Chinese doctors under undue and undeclared influence from extraneous forces, namely the pharmaceutical industry.
In turn, patients are at risk of receiving sub-optimal diagnosis and care and are put in harm's way by medication overuse.
On a positive note, the Chinese government is taking steps to alleviate the existing income and infrastructure discrepancies between the Eastern coastal areas and the countryside, which will improve general medical, and one hopes, mental health care.
Equally important, a whole generation of sophisticated, highly motivated psychiatric physicians and non-medical psychotherapists is coming of age (in the big cities), educated in part thanks to outside efforts by not-for-profit organizations such as the Chinese American Psychoanalytic Alliance (CAPA).
Regarding the proposed health care reform, China might conclude that there is little synergy between corporate business models and her huge population's need for accessible medical care.
The conflicts of interest that have come to shake US academia will need to be addressed here as well. At the same time, doctors' working conditions must be improved. Eventually, consideration should be given to the establishment of a rational tort system that does not simply copy the excesses of the US system. There is much reason for hope and much work to be done. Chinese society, patients and doctors will be better off for it.
The author is a US educated neurologist and psychiatrist based in New York City, and a faculty member of Columbia University and the Chinese American Psychoanalytic Alliance.
(China Daily 07/05/2010 page8)
http://www.chinadaily.com.cn/opinion/2010-07/05/content_10056660.htm
Quality psychiatric care is needed
Op-Ed By Dr. Maurice Preter (China Daily)
Updated: 2010-07-05 08:00
The recent spate of attacks on schoolchildren and the workers' suicides at the Foxconn factory in Shenzhen have again highlighted China's urgent need to balance economic progress with care for those left behind, and unable to cope with, the lightning speed of development.
Sustainable development is an avowed goal of Chinese government policy, and from a medical-psychological perspective, accessible, quality general medical and psychiatric care is a fundamental part of long-term, ecologically minded, peaceful societal progress.
However, it is an open secret that the medical profession in China is in disarray and rather ill-equipped to contribute to the solution of China's larger societal problems. Chinese physicians are overworked. They routinely see several dozen, if not a hundred patients a day, including those in urgent need of expert mental health treatment.
They are forced to accept absurdly low salaries and are consequently, generally disrespected. Pharmaceutical sales productivity incentives imposed by hospital administrations and by the wish to supplement meager earnings lead to a medical assembly line mentality that short-changes patients and frustrates doctors.
It comes as no surprise that, according to data cited in this newspaper (China Daily, March 25, 2010: "Doctors at receiving end in medical reform"), there are high levels of stress and depression among Chinese doctors.
Coincidentally or not, this year's most murderous school attack was perpetrated by a supposedly mentally ill physician.
This situation is unlikely to attract the needed numbers of highly intelligent and motivated students to the practice of medicine. This in turn stymies the development of quality medical care, and the future acquisition and transmission of clinical knowledge. However, the recent violent events are a cruel reminder that China must make the rational delivery of compassionate, sophisticated medical-psychiatric care an absolute priority.
Keeping in mind that for the foreseeable future, the majority of mentally ill and emotionally distressed patients in China will continue to receive their care from general (non-specialist) doctors, what is the current situation in my own field of practice?
Chinese patients seeking expert help for mental distress will often receive care from physicians educated without any knowledge of available non-drug based treatment options, such as psychodynamic psychotherapy, group therapy and other types of behavioral interventions.
While in the West the set ways of medicine, and especially psychiatric medicine, are increasingly coming under critical scrutiny, most Chinese psychiatrists limit themselves to simplistic, obsolete interpretations of Western biomedical models that de-emphasize empathic listening.However, quality medical care, and especially mental health care, begins with a well-trained and experienced physician who is able to create a therapeutic alliance with a suffering and often frightened, and ashamed patient.
By contrast, the lack of time spent with an individual patient (when there are countless individuals waiting to be seen), combined with the economic reality of multiplying one's salary by writing huge numbers of prescriptions puts Chinese doctors under undue and undeclared influence from extraneous forces, namely the pharmaceutical industry.
In turn, patients are at risk of receiving sub-optimal diagnosis and care and are put in harm's way by medication overuse.
On a positive note, the Chinese government is taking steps to alleviate the existing income and infrastructure discrepancies between the Eastern coastal areas and the countryside, which will improve general medical, and one hopes, mental health care.
Equally important, a whole generation of sophisticated, highly motivated psychiatric physicians and non-medical psychotherapists is coming of age (in the big cities), educated in part thanks to outside efforts by not-for-profit organizations such as the Chinese American Psychoanalytic Alliance (CAPA).
Regarding the proposed health care reform, China might conclude that there is little synergy between corporate business models and her huge population's need for accessible medical care.
The conflicts of interest that have come to shake US academia will need to be addressed here as well. At the same time, doctors' working conditions must be improved. Eventually, consideration should be given to the establishment of a rational tort system that does not simply copy the excesses of the US system. There is much reason for hope and much work to be done. Chinese society, patients and doctors will be better off for it.
The author is a US educated neurologist and psychiatrist based in New York City, and a faculty member of Columbia University and the Chinese American Psychoanalytic Alliance.
(China Daily 07/05/2010 page8)
Friday, July 2, 2010
Scientists Spot Gene Variants That Predict Longevity Grouping determined whether person lived to 100 with 77% accuracy
http://consumer.healthday.com/Article.asp?AID=640714
Thursday, June 17, 2010
A significant increase in polypharmacy involving antidepressant and antipsychotic medications.
Arch Gen Psychiatry. 2010 Jan;67(1):26-36.
National trends in psychotropic medication polypharmacy in office-based psychiatry.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 797, Baltimore, MD 21205, USA. rmojtaba@jhsph.edu
Abstract
CONTEXT: Psychotropic medication polypharmacy is common in psychiatric outpatient settings and, in some patient groups, may have increased in recent years. OBJECTIVE: To examine patterns and recent trends in psychotropic polypharmacy among visits to office-based psychiatrists. DESIGN: Annual data from the 1996-2006 cross-sectional National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in psychotropic polypharmacy within nationally representative samples of 13 079 visits to office-based psychiatrists. SETTING: Office-based psychiatry practices in the United States. PARTICIPANTS: Outpatients with mental disorder diagnoses visiting office-based psychiatrists. MAIN OUTCOME MEASURE: Number of medications prescribed in each visit and specific medication combinations. RESULTS: There was an increase in the number of psychotropic medications prescribed across years; visits with 2 or more medications increased from 42.6% in 1996-1997 to 59.8% in 2005-2006; visits with 3 or more medications increased from 16.9% to 33.2% (both P < .001). The median number of medications prescribed in each visit increased from 1 in 1996-1997 to 2 in 2005-2006 (mean increase: 40.1%). The increasing trend of psychotropic polypharmacy was mostly similar across visits by different patient groups and persisted after controlling for background characteristics. Prescription for 2 or more antidepressants, antipsychotics, sedative-hypnotics, and antidepressant-antipsychotic combinations, but not other combinations, significantly increased across survey years. There was no increase in prescription of mood stabilizer combinations. In multivariate analyses, the odds of receiving 2 or more antidepressants were significantly associated with a diagnosis of major depression (odds ratio [OR], 3.44; 99% confidence interval [CI], 2.58-4.58); 2 or more antipsychotics, with schizophrenia (OR, 6.75; 99% CI, 3.52-12.92); 2 or more mood stabilizers, with bipolar disorder (OR, 15.46; 99% CI, 6.77-35.31); and 2 or more sedative-hypnotics, with anxiety disorders (OR, 2.13; 99% CI, 1.41-3.22). CONCLUSIONS: There has been a recent significant increase in polypharmacy involving antidepressant and antipsychotic medications. While some of these combinations are supported by clinical trials, many are of unproven efficacy. These trends put patients at increased risk of drug-drug interactions with uncertain gains for quality of care and clinical outcomes.PMID: 20048220 [PubMed - indexed for MEDLINE]
Sunday, June 13, 2010
An Occupational Neurosis: A Psychoanalytic Case History of a Rabbi
An Occupational Neurosis: A Psychoanalytic Case History of a Rabbi
Maya Balakirsky Katz (2010).
AJS Review, Volume 34, Issue 01, Apr 2010 pp 1-31 http://journals.cambridge.org/action/displayAbstract?aid=7629776
AJS Review, Volume 34, Issue 01, Apr 2010 pp 1-31 http://journals.cambridge.org/action/displayAbstract?aid=7629776
Friday, May 7, 2010
Vers une meilleure intégration d’Internet à la relation médecins-patients | Conseil National de l'Ordre des Médecins
Vers une meilleure intégration d’Internet à la relation médecins-patients | Conseil National de l'Ordre des Médecins: "Vers une meilleure intégration d’Internet à la relation médecins-patients
06/05/2010
Sept Français sur dix consultent aujourd’hui Internet pour obtenir des informations en matière de santé . Devant l’essor de cette pratique, le Conseil National de l’Ordre des Médecins a convié le 4 mai dernier, experts, institutionnels et journalistes pour débattre de l’évolution de l’information santé en ligne et de son incidence dans la relation des Français avec leurs praticiens."
06/05/2010
Sept Français sur dix consultent aujourd’hui Internet pour obtenir des informations en matière de santé . Devant l’essor de cette pratique, le Conseil National de l’Ordre des Médecins a convié le 4 mai dernier, experts, institutionnels et journalistes pour débattre de l’évolution de l’information santé en ligne et de son incidence dans la relation des Français avec leurs praticiens."
Thursday, May 6, 2010
Current psychiatric classification and diagnostic scales - Are they sensitive enough to detect the lasting effects of early childhood adversity?
Original Articles | |||
Controlled cross-over study in normal subjects of naloxone-preceding-lactate infusions; respiratory and subjective responses: relationship to endogenous opioid system, suffocation false alarm theory and childhood parental lossM. Preter, S. H. Lee, E. Petkova, M. Vannucci, S. Kim and D. F. KleinPsychological Medicine, First View Articles articledoi:10.1017/S0033291710000838 (About doi), Published Online by Cambridge University Press 06 May 2010From the results:"Normal subjects, usually relatively insensitive to the TV effects of lactate infusion, in this study, given | |||
Tuesday, May 4, 2010
"Oedipe est le meilleur site français sur la psychanalyse"
- Le Monde interactif, supplément du 19 mai 2002.
Ouverture
Il y a un peu plus d'un siècle, un jeune médecin juif, intelligent, ambitieux, peu fortuné se posait quelques questions dont les réponses allaient avoir des répercussions nombreuses sur ses contemporains . Son premier objectif était de gagner sa vie , d'ouvrir un cabinet et de trouver une clientèle pour enfin pouvoir se marier. Comme tout homme jeune versé dans le domaine de la recherche, il rêvait de gloire, de grandes découvertes. Son travail dans le domaine de la neurobiologie, intéressant et novateur ne lui avait pas ouvert autant de portes qu'il avait pu l'espérer. La question de la correspondance anatomo-clinique qui avait nourri ses recherches se heurtait aux questions soulevées par les patients pour lesquels cette correspondance n'existait pas.
En France deux "écoles" interrogeaient, notamment grace à l'hypnose, cette difficulté épistémologique. L'école de Nancy prenait le risque de questionner des hypnotiseurs, non-médecins . A Paris, le professeur Jean-Martin Charcot, dont la célébrité reposait sur plusieurs découvertes importantes dans le champ de la neurologie, s'intéressait lui aussi aux manifestations provoquées chez certaines malades hospitalisées à la Salpêtrière et cataloguées " hystériques ". Ces malades présentaient des symptomes-notamment des paralysies- qui ne correspondaient pas à ce que l'on connaissait de l'anatomie et de la physiologie.Elles revivaient sous hypnose des scènes à caractère sexuel. C'est en faisant le saut qui passe du " bras " en tant qu'il peut être décrit en termes anatomiques, au bras en tant qu'il est une représentation imaginaire inscrite dans le langage, que Freud sans abandonner la question de la correspondance anatomo-clinique, s'aventure alors dans une autre voie celle d'une parole qu'il s'agit non seulement d'écouter mais d'entendre. Consciemment ou non, Freud cherche aussi à se connaître lui-même et se confronte aux énigmes de sa propre histoire. Cette démarche prendra toute sa dimension au cours des échanges épistolaires et lors de ses rencontres avec un autre médecin juif, son ami Wilhem Fliess, et plus tard, quand il entreprendra l'analyse de ses propres rêves. Pour écouter parler toute au long de la journée des patients, il était sans doute utile, pour le confort des deux protagonistes, d'inventer un dispositif. Freud ne supportait pas le regard de ses patients au cours des longues heures d'entretiens qu'il avait avec eux. En les allongeant sur un divan et en se plaçant derrière eux, il privilégie l'écoute sur le regard, il invente un dispositif congruant avec sa méthode. Il énonce la règle fondamentale qui invite ses patients à dire ce qui vient.
Très rapidement il rencontre un certain nombre de questions :
- la question de la réalité des faits racontés et parmi les récits qu'il entend, le problème lié à la véracité et à l'impact des actes de séduction sexuelle commis, selon le récit de ses patientes, dans leur petite enfance par un adulte, souvent un membre de la famille proche,en particulier le père. Freud élabore alors une série d'avancées qui problématisent cette question du traumatisme et débouche sur la théorie du fantasme qui met en avant l'importance du désir du sujet dans la mémorisation de son histoire infantile .
- la question du lien qui se noue entre l'analyste et l'analysant au cours de la cure . Il nomme transfert ce lien , précisant que le transfert doit se comprendre en référence aux images archaïques infantiles et s'interpréter en fonction des données propres à la cure.
- La question de la résistance et de la censure. L'interprétation donnée au patient ne conduit pas d'emblée à une adhésion de celui-ci. L'analysant tient à son symptôme, le défend en quelque sorte et peine à y renoncer.
Freud tout au long de sa vie et grâce à son travail a construit : Une méthode pour explorer le psychisme grâce à laquelle il lui a été possible d'élaborer une nouvelle théorie de l'appareil psychique ainsi que le dispositif de la cure dont il est avéré qu'elle entraîne pour les patients qui s'y prêtent des effets thérapeutiques. Après Freud, de nombreux psychanalystes ont contribués à affiner , modifier, élargir les champs ouverts par lui ,qu'il s'agisse de la théorie des groupes,de la pédagogie,de l'anthropologie etc.. où à l'intérieur même du champ analytique qui n'a cessé de s'étendre: enfants, nourrissons, psychosomatique etc... Des hommes et des femmes venus du monde entier ont commencé à pratiquer la psychanalyse , posant le problème de savoir qui pouvait se dire psychanalyste? Était-ce seulement l'adhésion à une théorie qui qualifiait le psychanalyste? Dans un premier temps deux principes furent retenus: Le psychanalyste doit avoir fait une analyse et en avoir sur lui-même éprouvé les effets, notamment en ce qui concerne le transfert et la résistance. Il doit avoir reçu une formation complémentaire et avoir pendant un certain nombre d'années pu exposer ses difficultés à un ou plusieurs analyste plus expérimentés que lui. La communauté analytique, s'est progressivement dotée d'associations locales regroupées au niveau international, d'instituts de formation, de revues nationales et internationales, de bibliothèques et à présent de sites internet... Depuis Freud, un nombre incalculable de patients par le monde ont fait une cure psychanalytique. La théorie psychanalytique a progressé et s'est enrichie d'apports multiples .Elle s'est aussi complexifiée au point que personne n'est aujourd'hui capables de faire le bilan de toutes les pistes explorées, de toutes les hypothèses avancées
Rien ne va plus
La psychanalyse est constamment prise dans des débats contradictoires. Elle est dénoncée par ceux qui en contestent le bien fondé sans toujours que leur propos apparaisse instruit de façon suffisante et pertinente. Elle est aussi l'objet de multiples débats au sein de ce qu'il est convenu d'appeler peut être improprement, la communauté analytique. Il en résulte des conflits ou la question du pouvoir n'est pas absente, des scissions et des rivalités plus ou moins importantes . Chaque scission a entraîné la création de nouvelles associations et de nouvelles structures qui se séparent, se regroupent, se combattent etc... Les clivages sont tels aujourd'hui qu'ils conduisent à se poser la question de l'existence de cette " communauté analytique " dont les contours semblent bien difficiles à tracer. Le plus souvent , il n'est même plus possible de renouer le dialogue. Les mots employés par les tribus voisines ont trouvé un sens différent et d'autres mots au contenu énigmatique sont venus au fil des ans s'ajouter à ceux de la langue commune au point pour l'analyste quittant sa tribu, d'éprouver parfois le sentiment étrange de se trouver en une terre étrangère et pourtant familière. Notre objectif n'est pourtant pas d'élaborer une plate-forme consensuelle entre tous les analystes, non plus qu'un illusoire " esperanto ". Nous souhaitons par contre aider ceux qui nous rejoindront à procéder à une lecture raisonnée des sites qui fleurissent désormais un peu partout à l'enseigne de la psychanalyse, participant à notre manière à la circulation de la parole et à la réaffirmation de l'importance de la psychanalyse dans le monde d'aujourd'hui. Ils y trouveront également un lieu ou ils pourront s'exprimer s'ils le souhaitent. S'il revient bien à chaque analyste pris un par un, de répondre du présent et de l'avenir de la psychanalyse, ceux qui voudront participer à la construction du site oedipe trouveront, nous l'espérons dans celui-ci, un moyen utile pour cette tâche.
Les sources juives de la psychanalyse Lacan lecteur de la Bible (28 mn) Gérard Haddad, Psychanalyste Centre Communautaire - Paris, novembre 2004
http://www.akadem.org/sommaire/themes/philosophie/4/1/module_466.php
Foreign accent syndrome(FAS)
Medicine Through Time Foreign accent syndrome(FAS) "When my voice have been changed"
FAS is a rare medical condition involving speech production that usually occurs as a side effect of severe brain injury, such as a stroke or a head injury. Two cases have been reported of individuals with the condition as a development problem and one assoc...iated with severe migraine. Between 1941 and 2009, there have been sixty recorded cases. Its symptoms result from distorted articulatory planning and coordination processes. It must be emphasized that the speaker does not suddenly gain a foreign language (vocabulary, syntax, grammar, etc); they merely pronounce their native language with a foreign or dialectical accent. Despite a recent unconfirmed news report that a Croatian speaker has gained the ability to speak fluent German after emergence from a coma, there has been no verified case where a patient's foreign language skills have improved after a brain injury (and in fact in the case of the Croatian girl, she lost her ability to speak Croatian).
Cross-posted from Medicine Through Time (Facebook)
http://www.facebook.com/permalink.php?story_fbid=121012817915007&id=348794679530
FAS is a rare medical condition involving speech production that usually occurs as a side effect of severe brain injury, such as a stroke or a head injury. Two cases have been reported of individuals with the condition as a development problem and one assoc...iated with severe migraine. Between 1941 and 2009, there have been sixty recorded cases. Its symptoms result from distorted articulatory planning and coordination processes. It must be emphasized that the speaker does not suddenly gain a foreign language (vocabulary, syntax, grammar, etc); they merely pronounce their native language with a foreign or dialectical accent. Despite a recent unconfirmed news report that a Croatian speaker has gained the ability to speak fluent German after emergence from a coma, there has been no verified case where a patient's foreign language skills have improved after a brain injury (and in fact in the case of the Croatian girl, she lost her ability to speak Croatian).
Cross-posted from Medicine Through Time (Facebook)
http://www.facebook.com/permalink.php?story_fbid=121012817915007&id=348794679530
Friday, April 30, 2010
Wednesday, April 28, 2010
Wednesday, April 21, 2010
Saturday, April 17, 2010
Letters - Perception and Distortion - NYTimes.com NYT Review of Books April 18, 2010
Letters - Perception and Distortion - NYTimes.com
Letters
Perception and Distortion
Published: April 15, 2010
To the Editor:
'The Shaking Woman,' by Siri Hustvedt: Seized (April 4, 2010)
As is the case in most presentations of “unexplainable” neurological-psychiatric symptoms, there are unspeakables in Siri Hustvedt’s book “The Shaking Woman” (April 4): the horror of a vague, transgenerationally transmitted memory of a witnessed wartime atrocity; the pain and fear of cumulative loss. Any attempt to put the unspeakable on paper will necessarily fall short, but Hustvedt’s sustained argument in the book is precisely that all categories — medical and philosophical — are in themselves subject to ambiguity.
Criticizing it for its failure to address the pain of caregivers is a non sequitur. The reviewer, I am afraid, fell into the same fallacy she accuses Hustvedt of: seeing and hearing only what she wanted to see and hear. In my work as a clinical and forensic neurologist-psychiatrist, I am used to seeing unspeakable emotional pain causing perceptual distortions. Neither literary creation nor its criticism are exempt from this fundamental observation.
MAURICE PRETER
New York
The writer is an assistant professor of clinical psychiatry at Columbia University and an adjunct associate professor of neurology at SUNY Downstate Medical Center.
Letters
Perception and Distortion
Published: April 15, 2010
To the Editor:
'The Shaking Woman,' by Siri Hustvedt: Seized (April 4, 2010)
As is the case in most presentations of “unexplainable” neurological-psychiatric symptoms, there are unspeakables in Siri Hustvedt’s book “The Shaking Woman” (April 4): the horror of a vague, transgenerationally transmitted memory of a witnessed wartime atrocity; the pain and fear of cumulative loss. Any attempt to put the unspeakable on paper will necessarily fall short, but Hustvedt’s sustained argument in the book is precisely that all categories — medical and philosophical — are in themselves subject to ambiguity.
Criticizing it for its failure to address the pain of caregivers is a non sequitur. The reviewer, I am afraid, fell into the same fallacy she accuses Hustvedt of: seeing and hearing only what she wanted to see and hear. In my work as a clinical and forensic neurologist-psychiatrist, I am used to seeing unspeakable emotional pain causing perceptual distortions. Neither literary creation nor its criticism are exempt from this fundamental observation.
MAURICE PRETER
New York
The writer is an assistant professor of clinical psychiatry at Columbia University and an adjunct associate professor of neurology at SUNY Downstate Medical Center.
Friday, April 16, 2010
A conversation between Siri Hustvedt and Maurice Preter MD
In 2006, the novelist and essayist Siri Hustvedt suffered an inexplicable seizure while speaking at a memorial service for her father. The seizures continued to occur, and the condition remains undiagnosed. Her most recent book The Shaking Woman or A History of My Nerves tells the story of her condition and explores her symptoms through the lenses of several disciplines: medical history, psychiatry, psychoanalysis, contemporary neuroscience, philosophy, and literature. Hustvedt has a PhD in English literature from Columbia and has worked as a writing teacher with psychiatric patients at the Payne Whitney Psychiatric Clinic in New York. Her web site is www.sirihustvedt.
Maurice Preter, MD is a practicing neurologist, psychiatrist, and psychotherapist. Dr. Preter received his training in neurology and psychiatry at the Albert Einstein College of Medicine, and is board certified in both specialties. He has done neuropsychiatric research in stress, anxiety, panic disorder, and psychological trauma. A member of the psychiatry faculty of Columbia University’s College of Physician’s and Surgeons, his particular interest is in the treatment of conditions that cross the conventional and limiting borders of psychiatry, neurology, and general medicine. His web site is www.psychiatryneurology.net.
Please join us for a discussion between Siri Hustvedt and Dr. Maurice Preter on unexplained medical symptoms, their meanings for patients and for doctors, and the vital importance of viewing illness, no matter how mysterious, in a narrative context.
Hosted by Dr. Rita Charon and the Program in Narrative Medicine.
Wednesday May 12th at 5:00 PM in the Faculty Club in the Physicians & Surgeons Building, 4th floor, Room #446.
Cross-posted from http://www.psychiatryneurology.net/News.html
PDF: http://psychiatryneurology.com/SiriHustvedt_MauricePreter_flyer.pdf
Click here to listen
Maurice Preter, MD is a practicing neurologist, psychiatrist, and psychotherapist. Dr. Preter received his training in neurology and psychiatry at the Albert Einstein College of Medicine, and is board certified in both specialties. He has done neuropsychiatric research in stress, anxiety, panic disorder, and psychological trauma. A member of the psychiatry faculty of Columbia University’s College of Physician’s and Surgeons, his particular interest is in the treatment of conditions that cross the conventional and limiting borders of psychiatry, neurology, and general medicine. His web site is www.psychiatryneurology.net.
Please join us for a discussion between Siri Hustvedt and Dr. Maurice Preter on unexplained medical symptoms, their meanings for patients and for doctors, and the vital importance of viewing illness, no matter how mysterious, in a narrative context.
Hosted by Dr. Rita Charon and the Program in Narrative Medicine.
Wednesday May 12th at 5:00 PM in the Faculty Club in the Physicians & Surgeons Building, 4th floor, Room #446.
Cross-posted from http://www.psychiatryneurology.net/News.html
PDF: http://psychiatryneurology.com/SiriHustvedt_MauricePreter_flyer.pdf
Click here to listen
Sunday, April 11, 2010
Thursday, April 8, 2010
Thursday, April 1, 2010
Wednesday, March 31, 2010
Sunday, March 28, 2010
Friday, March 26, 2010
Thursday, March 25, 2010
News in anxiety research
Panic disorder study just accepted for publication in Psychological Medicine
[http://journals.cambridge.org/action/displayJournal?jid=PSM]
[http://journals.cambridge.org/action/displayJournal?jid=PSM]
TITLE: Controlled cross-over study in normal subjects of naloxone-preceding-lactate infusions;
respiratory and subjective responses: Relationship to endogenous opioid system, suffocation false alarm theory and childhood parental loss (CPL)
Short Title: Controlled study of naloxone-lactate infusions in normals.
Maurice Preter1, MD, Sang Han Lee2, PhD, Eva Petkova3, PhD, Marina Vannucci4, PhD, Sinae Kim5, PhD, Donald F. Klein6, MD, DSc
1 Corresponding Author. Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY, and Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, NY.
Mailing address: 1160 Fifth Avenue, 112. New York, NY 10029, USA.
2 The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962.
3 Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, U.S.A.
4 Department of Statistics, Rice University, Houston, Texas 77251-1892.
5 Department of Biostatistics, University of Michigan, Ann Harbor, MI 48109.
6 Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Department of Child and Adolescent Psychiatry, New York University Langone Medical Center; Nathan S. Kline Institute for Psychiatric Research; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York.
ABSTRACT:
Background: The expanded suffocation false alarm theory (SFA; Preter and Klein, 2008) hypothesizes that dysfunction in endogenous opioidergic regulation increases sensitivity to CO2, separation distress and panic attacks. In panic disorder patients, both spontaneous clinical panics and lactate-induced panics markedly increase tidal volume, while normals have a lesser effect, perhaps due to their intact endogenous opioid system. We hypothesized that impairing the opioidergic system by naloxone could make normal controls parallel panic disorder patients’ response when lactate challenged.
Whether actual separations and losses during childhood (Childhood Parental Loss, CPL) affected naloxone-induced respiratory contrasts was explored. Subjective panic-like symptoms were analyzed although pilot work indicated that the subjective aspect of anxious panic was not well modeled by this specific protocol.
Methods: Randomized cross-over sequences of intravenous naloxone (2mg/kg) followed by lactate (10mg/kg), or saline followed by lactate were given to 25 volunteers. Respiratory physiology was objectively recorded by the LifeShirt. Subjective symptomatology was recorded.
Results: Impairing of the endogenous opioid system by naloxone accentuates tidal volume and symptomatic response to lactate. This interaction is substantially lessened by CPL.
Conclusions: Opioidergic dysregulation may underlie respiratory pathophysiology and suffocation sensitivity in panic disorder. Comparing specific anti-panic medications with ineffective anti-panic agents (e.g., propranolol) can test the specificity of the naloxone+lactate model. A screen for putative anti-panic agents and a new pharmacotherapeutic approach is suggested. Heuristically, the experimental unveiling of the endogenous opioid system impairing effects of childhood parental loss and separation in normal adults opens a new experimental, investigatory area.
Characteristics of young rural Chinese suicides: a psychological autopsy study
J Zhang, W Wieczorek, Y Conwell, X-M Tu, et al. Psychological Medicine. Cambridge: Apr 2010. Vol. 40, Iss. 4; pg. 581, 9 pgs
Abstract (Summary)
Background: Patterns of suicide rates in China differ in many ways from those in the West. This study aimed to identify the risk factors characteristic for young rural Chinese suicides.
Method: This was a case-control psychological autopsy (PA) study. The samples were suicides and living controls (both aged 15-34 years) from 16 rural counties of China. We interviewed two informants for each suicide and each control with pretested and validated instruments to estimate psychosocial, psychiatric and other risk factors for suicides.
Results: The prevalence of mental disorders was higher among the young Chinese who died by suicide than among the living controls, but was lower than among suicides in the West. Marriage was not a protecting factor for suicide among young rural Chinese women, and never-married women who were involved in relationships were about three times more likely to commit suicide than single women who were unattached. Religion/religiosity was not a protecting factor in Chinese suicide, as it tended to be stronger for suicides than for controls. Impulsivity was significantly higher for suicides than for controls. Psychological strain, resulting from conflicting social values between communist gender equalitarianism and Confucian gender discrimination, was associated significantly with suicide in young rural Chinese women, even after accounting for the role of psychiatric illness.
Conclusions: Risk factors for suicide in rural China are different from those in the West. Psychological strain plays a role in suicide. Suicide prevention programs in China should incorporate culture-specific considerations. [PUBLICATION ABSTRACT]
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