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Treatment options in obstructive sleep apnea

Vivek C. Shah, M.D., Gurpreet Singh, M.D., Pramod Kayathi, M.D., Steven Lippmann, M.D.

Obstructive sleep apnea
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder involving a decrease or a temporary halt in airflow despite an effort to breathe. It occurs during sleep with pharyngeal muscle relaxation, resulting in soft tissue collapse, blocking the upper airway. This results in partial reductions (hypopneas) and/or complete pauses (apneas) in breathing, that last at least 10 seconds. Most apneas continue for up to 30 seconds, but may persist for one minute or longer. This leads to reductions in blood oxygen saturation, with oxygen levels falling as much as 40% or more in severe cases. Most people with OSA snore loudly and frequently, with periods of silence when airflow is compromised; they then emit loud chocking, snorting, or gasping sounds as the airway reopens.
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A meeting of the World Federation of Biological Psychiatry Task Force on Men’s Mental Health

Leo Sher, M.D.

The members of the World Federation of Biological Psychiatry (WFSBP) Task Force on Men’s Mental Health met in Madrid, Spain in September 2014 to discuss the research and clinical directions in the field of Men’s Mental Health. Leo Sher, M.D. (USA), Zoltan Rihmer, M.D., Ph.D. D.Sc. (Hungary), Javier Didia-Attas, M.D. (Argentina), Jose de Leon, M.D. (USA), Shih-Ku Lin, M.D. (Taiwan), Carlos Roncero, M.D. (Spain), and Nestor Szerman, M.D. (Spain) participated in the meeting.

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Forensic psychiatric assessments: ethical issues

Leo Sher, M.D.

Forensic psychiatric evaluations fundamentally differ from routine provision of clinical care, despite significant overlap in how they are performed (1-9). The opinion generated by the interview could be helpful, harmful, or neutral to the person being evaluated. These points distinguish a clinical psychiatric interview from a forensic evaluation.

A proposal has been made for an ethical framework of forensic psychiatry, which considered that its practice was acceptable if it fulfilled two criteria: truth-telling (honesty) and respect for persons, which means respect for the right of the people evaluated by a forensic psychiatrist to be informed of the implications of the assessment before entering into the process (3).
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Dr. Robertas Bunevicius: a pioneer of DSM in Lithuania

Juste Buneviciute

Dr. Robertas Bunevicius was always inquisitive and uncertain truths attracted his attention. While studying at Kaunas University of Medicine in late 1970’s he had difficulty connecting Freudian philosophy with a Soviet definition of “sluggish schizophrenia.”  Even though both schools of thought had similarities: both systems erased a line between psychiatric disorder and health. According to Freud, we all have crazy thoughts and temptations, and it is normal; however, under the Soviet definition of “sluggish schizophrenia” we could put any originally thinking person and make him a psychiatric patient. In the Soviet Union, the diagnosis of “sluggish schizophrenia” was often used for political purposes to isolate dissenters or “radicals” not willing to accept occupation by placing them in mental health hospitals.
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Can you differentiate decisional capacity from competence?

Gurpreet Singh, M.D., Vivek C. Shah, M.D., Murali K. Kolikonda, M.D., Steven Lippmann, M.D.

Introduction
When determining a patient’s right and ability to accept or to refuse treatment, understanding decisional capacity and competence is important. Do you know the difference? When can your patient agree to or decline a recommended treatment? What should you do when your patient is not capable to make medical decisions?

Decisional capacity and competence requires that the patient is at or above the age of majority. This is the age at which a person is legally considered an adult and usually begins on one’s 18th birthday. However; this definition may vary from state-to-state.
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The Addictive Nature of Indoor Tanning

Cody J. Connor, BS

While many cultures strongly endorse the cosmetic effect of tan skin, the dangers of attaining it often evade the minds of those who seek that “beautiful” status. In fact, for many of those that do consider these dangers, the remote consequences do not seem to outweigh the immediate benefits. Thus, the perfect storm for addiction is born.

The toxic consequences of excessive UV exposure are well-established, ranging from acute effects like cutaneous burns (erythema), tanning, and local immunosuppression, to more long-term consequences like photoaging , immunosuppression, and photocarcinogenesis [1].
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Paradoxes of US psychopharmacology practice

Jose de Leon, M.D.

This editorial proposes that 2013 may someday be known as the year psychiatry was at a crossroad. Practicing psychiatrists were pressured with paradoxical messages including (1) assurances from the National Institute of Mental Health (NIMH) that better psychiatric medications are forthcoming, which would decrease the impact of mental illness, even as pharmaceutical companies are leaving the field because they have failed to produce revolutionary new medications, (2) encouragement from the  American Psychiatric Association (APA) to use the DSM-5, which further increases the prevalence of mental illness, and its apparent agreement with overprescription of psychiatric medications to control behaviors, even if they are not a consequence of severe mental illness.
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Marijuana warning: cognitive decline in adolescents

Vivek C. Shah, M.D., Murali K. Kolikonda, M.D., Suneela Cherlopalle, M.D., Steven  Lippmann M.D.

Okay, marijuana is being legalized in many places across this country. Lots of people smoke pot. Some of them may have the impression that governmental legalization of this drug implies safety. What should you tell your adolescent patients?

Cannabis is one of the most widely used drugs in the world. Because of legalization in several states and decriminalization campaigns, many people, especially adolescents, might erroneously misinterpret this as a sign that the drug is harmless. However, it has profound adverse effects on the brain, especially for cognition.
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