Wednesday, November 4, 2009

Testifying for civil commitment

B. Todd Thatcher, DO, Forensic psychiatrist, Valley Mental Health Forensic Unit, Salt Lake City, UT

Douglas Mossman, MD, Director, Glenn M. Weaver Institute of Law and Psychiatry, University of Cincinnati College of Law, Director, Forensic Psychiatry Fellowship, University of Cincinnati College of Medicine, Cincinnati, OH

Testifying in civil commitment proceedings sometimes is the only way to make sure dangerous patients get the hospital care they need. But for many psychiatrists, providing courtroom testimony can be a nerve-wracking experience because they:

•lack formal training about how to testify
•lack familiarity with laws and court procedures
•fear cross-examination.

Training programs are required to teach psychiatry residents about civil commitment but not about how to testify. Residents who get to take the stand during training usually do not receive any instruction. Knowing some fundamentals of testifying can reduce your anxiety and reluctance to take the stand and help you to perform better in court.

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Listen to Dr. Mossman explain how to prepare to testify in civil commitment proceedings

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Tuesday, November 3, 2009

New algorithm for pediatric bipolar mania

Robert A. Kowatch, MD, PhD, Professor of psychiatry and pediatrics, Director of psychiatry research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Jeffrey R. Strawn, MD
, Clinical fellow, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Michael T. Sorter, MD, Associate professor of psychiatry and pediatrics, Director, division of psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Five recent randomized controlled trials (RCTs) have demonstrated the efficacy of atypical antipsychotics for treating bipolar disorder in children and adolescents, but 4 of these 5 trials remain unpublished. The lag time between the completion of these trials and publication of their results—typically 4 to 5 years—leaves psychiatrists without important evidence to explain to families and critics why they might recommend using these powerful medications in children with mental illness.

This article previews the preliminary results of these 5 RCTs of atypical antipsychotics, offers a treatment algorithm supported by this evidence, and discusses how to manage potentially serious risks when using antipsychotics to treat children and adolescents with bipolar disorder (BPD).

Do psychiatrists support the public option?

Henry A. Nasrallah, MD

Like everyone else, I could not avoid being swept up by the national debate about how to reform our health care system. The debate has been highly politicized, with the liberal left strongly supporting and the conservative right vehemently opposing a single-payer government-run public option (but keeping Medicare and Medicaid). Independents seem to waver between the major overhaul of a public option and making the system more competitive and less expensive.

So I started thinking: where do U.S. psychiatrists stand on a public health care option? I decided to formulate a hypothesis and test it by polling a sample of Current Psychiatry readers. My hypothesis: A substantial proportion (>60%) of practicing U.S. psychiatrists favor a single-payer public option. My rationale: My hunch was that what we psychiatrists deal with in clinical practice may shape and predict how we think about health care, irrespective of our politics.

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