The Journal of clinical psychiatry
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We estimate in dollar terms the economic burden of depression in the United States on an annual basis. ⋯ Depression imposes significant annual costs on society. Because there are many important categories of cost that have yet to be estimated, the true burden of this illness may be even greater than is implied by our estimate. Future research on the total costs of depression may include attention to the comorbidity costs of this illness with a variety of other diseases, reductions in the quality of life experienced by sufferers, and added out-of-pocket costs resulting from the effects of this illness, including those related to household services. Finally, it may be useful to estimate the additional costs associated with expanding the definition of depression to include individuals who suffer from only some of the symptoms of this illness.
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Case Reports
Successful management of patients with "multiple chemical sensitivities" on an inpatient psychiatric unit.
Much controversy exists over the diagnosis, etiology, and treatment of "multiple chemical sensitivities" also known as "environmental illness." The experience of multiple nonspecific reactions to numerous environmental agents leads to these diagnoses. Due to skepticism surrounding the validity of these patients' complaints, they are often referred for psychiatric evaluations, but successful management on a psychiatric inpatient unit can be complicated because of their unique presentations. ⋯ These patients benefited greatly from a serious, nonjudgmental, comprehensive approach to the evaluation of their multiple complaints. Despite the absence of any positive organic findings, each felt that her experiences had been validated, and each subsequently improved. When evaluating similar patients, clinicians should be aware of useful, effective management strategies and should avoid overt skepticism and confrontation.
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The severely mentally ill face many roadblocks, not the least of which is discrimination by the government and by insurance companies. The inadequate coverage allowed the severely mentally ill by the insurance industry, Medicare, and Medicaid is often as little as one fifth or less the coverage allowed other serious illnesses. ⋯ As the federal government prepares for essential health care cost reform, it is imperative that policy leaders, physicians, and mental health care advocates demand equal treatment under the law for the severely mentally ill. The Equitable Health Care for Severe Mental Illnesses Act of 1992 can provide a model for such action.
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Review Comparative Study
Comparison of SPECT applications in neurology and psychiatry.
The following presentation provides an overview of SPECT brain imaging applications in both neurologic and psychiatric disorders. Specific findings in cerebrovascular disease, dementia, and epilepsy are described in order to highlight the role SPECT plays in distinguishing primary organic disease from primary psychopathology. ⋯ The role of network imaging analysis across groups in psychiatric subjects is contrasted to its roles in neurologic disorders. The degree to which both neurologic and psychiatric pathology seen on SPECT exceeds that observed through structural modalities is defined.