Key Points Background Treatment-resistant depression (TRD) refers to an inadequate response to at least one antidepressant given in sufficient doses and for an appropriate duration. History Despite the recent advances in treatment of depression, only 30%–40% of patients achieve remission…
Key Points The immediate mechanism of action of modern antidepressants (“immediate effects”) involves influencing the function of one or more monoamine neurotransmitter systems (serotonin, norepinephrine [noradrenaline], or dopamine). Influencing monoaminergic function has been shown to result in several changes in…
Key Points Background Among patients with a psychiatric illness, treatment adherence is associated with better treatment outcomes, a lower risk of relapse and hospitalization, and better adherence to treatments for co-morbid medical illnesses. However, barriers to adherence are common and…
Key Points One can approach the study of the brain and its pathophysiology from various perspectives with different levels of resolution: molecular, genetic, cellular, synaptic, systems, and behavioral. Pathological processes and therapeutic interventions can target one or more of these…
Overview The purpose of this chapter is to give psychiatric providers of consultation-liaison (C-L) services an understanding of the complex business aspects of their work. Understanding that appropriately adhering to the often-confusing guidelines for reimbursement can be stressful to clinicians…
Overview The practice of medicine is focused on disease, not health, and on treatment, not primary prevention. Therefore, it is not surprising that physicians have difficulty maintaining their own health, minimizing stress, and preventing burnout in their own lives. The…
Overview Historical trends in psychiatry over the last century mirrored developments in the U.S. healthcare system more broadly that promoted system re-design to provide safer and more personalized, cost-effective, and high-quality health care. Care re-design in the treatment of psychiatric…
Overview Legal issues are common and acknowledged, although rarely welcomed, aspects of modern medicine. Physicians respond to these issues in various ways, ranging from denial of their existence, to resentment at the perceived intrusion into the patient care they create,…
Overview Race, ethnicity, and culture may all exert a tremendous impact on medical diagnosis, treatment, and outcomes. This is especially true in psychiatry, given the prominent role that culture plays in patients' interpretation and management of symptoms that fall within…
Overview Psychiatric consultation to obstetric patients typically involves evaluating and treating an array of psychopathology. Once thought to be a time of emotional well-being for women, studies now suggest that pregnancy does not protect women from the emergence or persistence…