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Placebo: Far More than a Sugar Pill

The word “placebo,” often denigrated by psychopharmacology skeptics as “the sugar pill” is a very misunderstood concept in psychiatry.

In order to gain approval for prescription in the United States, the Food and Drug Administration (FDA) requires clinical trials of between five and ten thousand patients before approving new medications. The gold standard for clinical trials is the double-blind placebo controlled study, in which half the enrollees are given a capsule...
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Timing is Everything: Conjoint Sessions with Couples in Crisis

Couples and family therapy is among the most rewarding work the psychiatrist performs. It is also among the most challenging given that both interpersonal and intrapsychic factors are in play, and the mindsets and motivations of the participants are not always what they seem to be. Despite trying to assess situations before the initial visit, the psychiatrist can wind up in some hairy situations, as I am about to relate.

Over the years I...
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Why Psychiatrists Should Make House Calls

Seeing psychiatric patients outside the office can generate controversy over boundary issues. But over time I have concluded that as long as the encounter is clearly in the best interests of the patient, then “house-calls” are not only justified; often they provide invaluable information.

Other than seeing psychiatric inpatients during my early practice years, my first out-of-the-office encounter occurred when I evaluated a demented nursing-home patient. The man had barricaded himself in his ward room behind...
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Coping with Bipolar Disorder During the Holidays: The Importance of Staying in Your Rhythm

For people living with Bipolar Disorder, holiday times can present a real challenge. It’s all too easy to slip into a false sense of security and disregard the routines that contributed to successful coping, especially if mood has been stable for a long time. Follow these guidelines and you and your psychiatrist won’t have a mess to clean up in the weeks after New Year.

Let’s start with your medication regimen. If you, your doctor and your psychotherapist...
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Get Those Endorphins Going and Laugh Your Way Through the Holidays

I don’t know who coined the phrase, “Laughter is the best medicine,” but I first connected the idea of laughter and health when I was little. My mother, a voracious reader of whodunits like Perry Mason and Agatha Christie, subscribed to one and only one magazine: the monthly Reader’s Digest, which always featured several pages of jokes and witticisms under the title of Laughter, the Best Medicine.

I didn’t acquire the taste for recreational reading until long...
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What’s in Your Medicine Chest? Opiate Medications: The Goods, Bads, and the Very Very Uglies

Opiate medications are among the oldest and most commonly prescribed drugs in the medical pharmacopeia. They are also among the most rapidly addicting and most lethal. Whereas untreated acetaminophen overdose kills in days from liver failure, unless reversed by the antidote naloxone, opiate overdose stops respiration in minutes, especially when mixed with alcohol or benzodiazepines.

The word opiate comes from the poppy extract opium, whose active ingredients morphine and codeine were not categorized until the early 1800’s....
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Should I Take an Antidepressant for My Depression?

One of the first questions new patients ask is whether or not they need to take medication for their depression?  What a loaded question! And an important one.

Before prescribing anything—be it psychotherapy, medication, or a combination of both—I tell patients what they need is a relationship with a doctor they can trust.

The first thing to establish is the diagnosis: to what degree is the depression pathological, or is it the normal emotional response to disappointment. In...
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The Paris Terrorist Attacks: Understanding the Psychology of Ideological Mass Murder and What We Can do About It

Effective Psychiatric Treatment welcomes Dr. Michael Welner, Chairman of The Forensic Panel and one of America’s most accomplished forensic psychiatrists. Dr. Welner has consulted on numerous mass killings, most recently the Aurora movie theater shooting in Colorado. He has been a key contributor to landmark Congressional legislation (HR 2646) to dramatically upgrade crisis psychiatry intervention. Dr. Welner is responsible for a number of innovations in forensic science. His research includes online surveys in which the public–...
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It’s All in the Family: Involving Family in Effective Psychiatric Treatment

Confidentiality is a frequent issue in clinical practice; should or shouldn’t a clinician involve significant others, especially family, in an identified patient’s psychiatric care? And, assuming the answer is yes, to what extent does the treater solicit information from or disclose information to the family?

When Bob Dylan said, “The times, they are changing,” he could well have been referring to psychiatric treatment. From the 1930’s through the 1980’s psychoanalysis was the Cadillac of psychiatric treatment. Information...
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