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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.

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.

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.

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].

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.

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.

Nursing metaparadigm and person-centered care

Yulin Chu, N.P.

The metaparadigm of nursing distinguishes nursing from any other discipline such as biology, sociology, or psychology (Jonson et al., 2012).  Initial consensus on the metaparadigm concepts in nursing was proposed by Fawcett in 1984. According to Fawcett (1984), metaparadigm, as the central concepts of nursing, contains person, environment, health, and nursing. These four concepts represent the phenomena of interest to nursing discipline, which are under the umbrella of nursing metaparadigm.

Testosterone and suicidal behavior in women with bipolar disorder

Leo Sher, M.D.

Multiple lines of evidence suggest that testosterone may affect mood and behavior both in males and in females. However, the role of testosterone in the pathophysiology of suicidal behavior remains unclear. Studies of the relation between testosterone and suicidal behavior have been mostly focused on male populations and produced inconsistent results. The variations between the results of the studies of the relation between testosterone and suicidal behavior could be related to many factors including differences in sample selection criteria and differences in time intervals between suicide attempts and blood sampling. We have recently published the results of the first study on the relation between testosterone and suicidal behavior in females (1).

Sleep disordered breathing in hyperactive children

Suneela Cherlopalle, M.D., Murali K. Kolikonda, M.D., Manasa Enja, M.D., Steven Lippmann, M.D.

You are in your office evaluating a child with hyperactivity and inattention. The parents want quick intervention;  the teacher suggests to “start medication” now. Under pressure, you are considering attention deficit hyperactivity disorder (ADHD), and the child appears to fit the criteria. However, sleep disordered breathing (SDB) and ADHD can present similarly, with hyperactivity and inattentiveness. So similarly, that mis-diagnoses can occur. Erroneous diagnosis leads to ineffective treatment and may make things worse.

Fortunately, office-based screening with a history from the parents about the child’s sleep can quickly help rule out sleep disordered breathing.