The role of personal therapy in psychiatric residency training: a survey of psychiatry training directors.

OBJECTIVE: The authors examine the current place of personal therapy for residents in U.S. training programs. METHODS: All U.S. training directors were provided an anonymous survey assessing current attitudes and practices with regard to personal therapy and training director perception of their residents' use of therapy. RESULTS: Training directors generally believed that personal therapy is useful during training, but fewer than one-third of residents seek therapy during residency. Program characteristics associated with the use of personal therapy by residents included training director beliefs in the value of therapy to mitigate personal problems, active encouragement by the training director to seek therapy, programmatic supports to reduce the cost of therapy to residents, and geographic location. CONCLUSION: The proportion of residents seeking personal therapy is falling, despite training directors' perceptions of the benefit of therapy to residents. This study identified practices promoting a culture in which residents seek therapy.

Electroconvulsive therapy in patients taking monoamine oxidase inhibitors.

Concerns have been expressed regarding the use of general anesthesia for electroconvulsive therapy (ECT) in patients taking monoamine oxidase inhibitors (MAOIs). We review the published literature and present 4 new cases and conclude that there is no evidence of a dangerous interaction between ECT and MAOI use. In general, a cautious approach would be to discontinue MAOIs before ECT if the medication has not been helpful; however, there is no need for a washout interval before starting ECT. Furthermore, if there is otherwise a reason for continuing the MAOI, it can be continued during index ECT or initiated during maintenance ECT.