Lloyd Sederer

Preface Acknowledgements 1 Psychotic Disorders 2 Mood Disorders 3 Anxiety Disorders 4 Personality Disorders 5 Substance-Related Disorders 6 Eating Disorders 7 Disorders of Childhood and Adolescence 8 Cognitive Disorders 9 Miscellaneous Disorders 10 Special Clinical Situations 11 Antipsychotics 12 Antidepressants 13 Mood Stabilizers 14 Anxiolytics 15 Miscellaneous Medications 16 Major Adverse Drug Reactions 17 Psychological Theories 18 Legal Issues Index

Neurotechnology refers to the science of applying our emerging understanding of the brain, consciousness, thought, and higher-order activities of the mind into developing technologies. The tools of neurotechnology, however, are not new for psychiatrists.

Screening data on obesity and smoking among adult outpatients in state-operated clinics were collected and analyzed by the New York State Office of Mental Health to determine relationships between demographic and clinical risk factors and obesity and smoking. Predictors of weight loss and smoking cessation were examined. Individuals enrolled in 2010-2012 with two or more valid body mass index measures and two or more valid smoking measures (N=22,574) were selected. Chi square tests examined associations between demographic and clinical risk factors and obesity and smoking. Multivariable logistic regression identified predictors of weight loss and smoking cessation. The prevalence of obesity and smoking was 45% and 50%, respectively. The odds of losing weight or remaining at a stable weight were higher among males (versus females), individuals ages ≤49 (versus ≥50), smokers (versus nonsmokers) at baseline, and individuals with diabetes (versus without diabetes). The odds of gaining w...

In October 2016, the 75-minute play The One With Friends premiered at the UCLA Center for Health Services and Society in a university theater, telling a story about how a common media experience, in this case the popular ’90s television series Friends, has the power to foster relationships and heal broken hearts. It also addressed the reigning stigma about mental illness in the United States. In December 2016, the Center staged the production in New York City. It opened with video public service announcements (PSAs) developed by Bring Change to Mind, the wonderful nonprofit organization created by Glenn and Jesse Close devoted to ending the stigma and discrimination surrounding mental illness. The short, lively PSAs told short stories of people like you and me with mental illness, stories of recovery and of hope. Enter a comedian (Lindsey Moore Ford) to warm up the audience. She reappears between each of the six or so acts to leaven the material with humor, since the story’s focus is on human struggle and loneliness. The plot then begins: a young man (Nick McLoughlin, as Callum) meets a young woman (Miranda Wynne, as Lucy) in a Santa Monica coffee shop. They are both depressed, hiding it, and doing what depressed people tend to do: pushing each other away even though what they desperately need whether they know it or not is each other’s company. She is writing a play that portrays a reunion of Friends’ characters some 10 years after the show ended. The near-entirety of the play shows the experience of the two growing closer and more accepting of each other in the recognition that they see themselves in the show’s characters—Ross, Rachel, Monica, Joey, Chandler, and Phoebe—and those characters’ supportive relationships. Through that identification the two begin to find themselves in each other and imagine finding the meaningful connections with other people that have so far eluded them. Almost as an afterthought, a third character is introduced later in the play, a hopelessly narcissistic young woman (Chloé Hung, as “The Model”), whose role is to suggest that we give others with mental health problems a chance, no matter how difficult that might be. There were about 40 people in the undergraduate performance I attended at the NYU Tisch School, in one of their intimate theaters. The audience mirrored the actors and story, principally NYU students, friends and family of the cast, or ardent fans of the TV show Friends, which ran from 1994 to 2004 (and rivaled Seinfeld for ratings). I was none of these and have watched only a few episodes of Friends, so my perspective is not quite what it might be had I been a fan, like a vast number of people in this country, past and present. Friends told the story of 20-somethings alone—but not too lonely or too alone because they had each other—in the big city called New York. Narrative has become part of medicine and medical education. It is a means for patients, family members, caregivers, and physicians to work through complicated emotions, make connections, build a firmer identity, and promote healing. To be truly effective, physicians, nurses, indeed any health care professional needs to be attuned to the dreams, not just the nightmares, of the person they seek to help, to be emotionally open enough to try to understand their patients’ lives to better know how to help them. This play models this healing power of narrative—the “talking cure” but without any physician—as the young man and woman reveal their troubles to each other, and their candid self-revelation brings them some measure of greater peace and self-acceptance and mitigates the stigma of mental illness. This play about two depressed young people acknowledges the role of traditional depression treatments, like psychotherapy and antidepressant medications, for helping depressed people feel better. But its primary message is that those medical conventions need to be complemented with the power of attachment to others. Attachment is the royal road to recovery from despair; it is deeply needed to enable people to survive the agony of mental anguish and the killing capability of loneliness (especially for people with depression, but for all of us as well). The play illustrates with its actual characters, and its references to those in Friends, that human connection is the most powerful tool we have for a good and rich life. The play itself is an intervention in an attempt to change hearts and minds. The creative team behind the play The One With Friends starring Nick McLoughlin and Miranda Wynne.

Quality assurance demands that health professionals meet the timeless mandate of helping (when we can) and doing no harm. The delivery of quality care has been profoundly influenced by systems of managed care, which may represent the principal trend in organized medicine in the 1980s. This chapter first defines quality and quality assurance. We then define managed care and managed mental health care. The implications of managed care on patients and health professionals are then addressed. Finally, we discuss examples of what has been done and what can be done to help ensure the continued provision of quality care in a cost-conscious society.

Clozapine remains the only medication approved for treatment-resistant schizophrenia. But underuse is the norm. In 2010, the New York State Office of Mental Health began a multifaceted initiative to promote the evidence-based use of clozapine. From 2009 to 2013, in the absence of a well-funded pharmaceutical marketing campaign, the proportion of new clozapine trials among all new outpatient antipsychotic trials increased 40% among adult New York Medicaid recipients with a diagnosis of schizophrenia. The largest gains occurred in state-operated clinics. New York's experience demonstrates the feasibility of making clozapine more accessible to patients who stand to benefit most.

That some therapists engage in sexual misconduct with patients has been unequivocally established. In recent years, however, some patients' allegations of sexual misconduct have been determined to be false. This paper describes four cases in which hospitalized psychiatric patients made false allegations. Such allegations may result from patients' seeking to gain monetarily or in other ways or from a desire for retaliation or revenge against a clinician who they believe has scorned, abandoned, or otherwise mistreated them. In other cases, especially among patients with a history of severe trauma, a patient's psychopathology may be inadvertently stimulated by diagnostic, treatment, or milieu activities. The authors recommend specific institutional responses to allegations of sexual misconduct, such as forming a clinical investigative team, conducting a physical examination, and reporting the charge to outside agencies or investigators when appropriate. Because false claims can have disastrous effects on all involved, clinicians should understand the presentations of such claims and the motivations behind them, and institutions should carefully develop a set of procedures for responding to them.