The Psychiatric clinics of North America
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Psychiatr. Clin. North Am. · Sep 2009
EditorialDevelopments in the treatment and diagnosis of anxiety disorders.
Anxiety disorders occur frequently, begin at an early age, significantly impair patients' lives, and are often associated with other comorbid conditions. Despite impressive improvements in the treatment of anxiety disorders in the last decade, the mechanisms leading to comorbidity and the processes responsible for therapeutic change remain unclear. Within this context, clear and precise definitions of the putative active ingredients are needed in order to further improve treatments. This article reviews these critical issues and sets the stage for the other articles in this special issue.
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This article presents the current evidence base for pharmacotherapy of generalized anxiety disorder (GAD) and an update on the phenomenology of GAD and its association with other psychiatric and somatic conditions. It discusses nosological issues and suggests ways to improve recognition, treatment, and care for patients who have GAD.
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Psychiatr. Clin. North Am. · Jun 2009
Review Case ReportsEthical issues in perinatal mental health.
The principles of autonomy, beneficence, nonmaleficence, and justice can guide clinicians in finding ethical approaches to the treatment of women who have psychiatric disorders during preconception, pregnancy, and postpartum. Table 1 summarizes some clinical dilemmas in perinatal mental health care, the ethical conundrums posed by these situations, and guiding principles or tools that can help clinicians resolve ethical conflicts. The concept of relational ethics helps resolve apparent mother-offspring ethical conflicts, and the practice of preventive ethics helps anticipate and reduce the risk of ethical dilemmas and adverse clinical outcomes. ⋯ When screening for maternal psychiatric symptoms, ensure that the benefits of screening outweigh the ethical costs by designing effective follow-up systems for helping women who have positive screens. When treating women of reproductive age for psychiatric disorders, proactively discuss family planning and, when appropriate, the anticipated risks of the illness and the treatment during future pregnancies. Offer preventive interventions to reduce these risks.
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The field of psychiatric research ethics has evolved in recent years. This evolution seems to stem from the efforts of various groups (eg, medical ethicists, regulatory bodies, and the profession's own association, the APA) and from increased understanding of the endeavor of psychiatric empirical research. Current data regarding mental illness highlight the need for the continued expansion of psychiatric research to help relieve the suffering of the many individuals whom mental illness affects. The ethics for psychiatric research should parallel this expansion of psychiatric research to ensure that studies sufficiently address ethical considerations and thus foster the proper, delicate balance between progress and protection (see Table 1).
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Psychiatr. Clin. North Am. · Mar 2009
ReviewReview of pediatric attention deficit/hyperactivity disorder for the general psychiatrist.
Attention deficit/hyperactivity disorder (ADHD) is a common and impairing psychiatric condition, affecting significant numbers of children and adolescents. General psychiatrists serve, both by choice and out of necessity, in the assessment and treatment of children and adolescents who have ADHD and in the education of patients and their families. ⋯ Background information, recent relevant research, current evidence-based practice guidelines, and tips for clinical practice are reviewed in this article. The information is presented in a question-answer format.