Buspirone augmentation of fluoxetine in obsessive-compulsive disorder.

Eleven obsessive-compulsive patients underwent a prospective open-label trial of fluoxetine monotherapy followed by buspirone augmentation. The combination therapy was statistically superior to fluoxetine monotherapy. The results point to the importance of the 5-HT1a receptor in obsessive-compulsive disorder.

Bioethics: communication and decision-making in advanced disease.

Effective communication is the cornerstone of excellence in patient care, and breakdown in communication is a common problem leading to requests for bioethics consultation. In palliative medicine, issues involving end-of-life decisions inherently involve many potential ethical concerns. Ensuring good communication among the physician, health care professionals, patient, and family will facilitate care, and avoid ethical problems. This chapter will address communication with patients, families, and health care professionals. Common ethical concerns such as withholding and withdrawing treatment modalities, medical futility, euthanasia, and assisted suicide will be discussed.

Psychosocial care in advanced cancer.

In palliative care, the focus is management of major symptoms and complications, and psychosocial support of the patient and family. Approaching the end of life, the patient's needs move beyond physical care to include the psychological, social, and spiritual dimensions. The main psychosocial interventions are counseling, education, and practical services directed at the needs identified by the multidimensional/multidisciplinary assessments. We will present the roles of the various team members and methods of psychosocial assessment.

Medical and osteopathic boards' positions on chaperones during gynecologic examinations.

OBJECTIVE: The objective of this study was to determine whether United States medical or osteopathic boards have opinions, position statements, or policies on chaperone use, and whether any state laws regulate chaperone use. METHODS: United States Medical and Osteopathic Boards were surveyed by mail to determine whether policies, opinions, positions, or laws exist regarding use of chaperones during gynecologic examinations. We sent the survey to executives at 67 state boards, identified by a list from The Federation of State Medical Boards. Our main outcome measure was positive response to the survey questions. RESULTS: Of 67 targeted sites, 61 responded (91%). Fourteen sites (23%) reported having informal or unpublished opinions recommending chaperones. Eleven sites (18%) reported having positions related to chaperones that have been published for their physicians. Four sites (6.5%) reported having policies specifically related to chaperone use. Thirty-two sites (52.5%) reported that they do not have opinions, positions, or policies related to chaperone use. No site reported state laws governing chaperone use. CONCLUSION: Response to our survey showed no concensus among state medical boards on the use of chaperones, leaving doctors and patients to decide for themselves whether they want or need chaperones present during gynecologic examinations.

Serum and red cell folate concentrations in outpatients receiving lithium carbonate.

We measured serum and RBC folate levels in 17 outpatients taking lithium for the prophylaxis of recurrent major affective disorder. In contrast to a previous report, we found no evidence for low folate concentrations or for any significant correlation between folate levels and affective morbidity.

Palinopsia: a review of the literature.

The literature on palinopsia (visual perseveration) is reviewed, utilizing case reports of 46 patients who demonstrated this symptom. The most common etiologies for this symptom are space-occupying lesions, cerebral infarct, and seizure activity. The vast majority are due to central nervous system pathology occurring in the posterior (occipital or parieto-occipital) region, often in the right hemisphere. Proposed mechanisms for palinopsia are also discussed.

The use of placebo in diagnosing psychogenic seizures: who is being deceived?

Induction procedures have been employed by some neurologists as a method of attempting to determine whether paroxysmal events experienced by the patient are psychogenic in origin. Although various techniques are used, those involving injection of intravenous saline and placebo patches are the focus of this article because they involve deception of the patient and raise the greatest ethical concerns. Issues of potential harm to the patient are examined in light of the typical psychological profile of patients who have psychogenic seizures. In addition, reliability of the procedure, possible benefit to the patient, and alternatives to using the procedure are considered. Finally, the question of whether there is ethical justification to consider induction procedures as an acceptable exception to informed consent is discussed. The authors argue that there is little if any justification for using induction procedures involving placebos, and that when the procedure is considered justifiable it should be done only if examination by a mental health professional discloses no psychological contraindications to proceeding and if a debriefing of the patient explaining the process and purpose of the induction is to take place following the procedure.

Informed consent for case reports: the ethical dilemma of right to privacy versus pedagogical freedom.

A new international standard of editorial policy calls for written informed consent by the subject of every case report. Although this appears to be ethically appealing, the authors posit that in some situations, requesting informed consent may be unethical, can harm patients, and may erode the use of case reports as a valuable teaching method in psychiatry and psychotherapy. The authors discuss concerns regarding this new policy for mental health publication based on issues of transference, countertransference, best interest of the patient, and practicality.

Palinopsia posing as a psychotic depression.

The experience of visual images appearing as well-described persons and objects, either familiar or unfamiliar to the patient, has frequently prompted psychiatric evaluation for apparent psychotic or schizophrenic disorders. A case of apparent psychotic depression is reported, in which the symptoms were due to the patient's experience of palinoptic images. Answers to particular questions in the initial interview can obviate the need for psychiatric consultation, as various consistencies have been reported in the non-psychiatric symptom of palinopsia.