Neuropsychiatric aspects of concussion.

Over the past decade, concussion has become the most widely discussed injury in contact sports. However, concussions also occur in several other settings, such as non-contact sports, elderly individuals, young children, military personnel, and victims of domestic violence. Concussion is frequently undiagnosed as a cause of psychiatric morbidity, especially when the patient has no history of loss of consciousness or direct head trauma. Almost all of the extant literature focuses on traumatic brain injury and assumes that concussion is merely a mild form of traumatic brain injury, which has resulted in a lack of understanding about what concussion is, and how to diagnose, monitor, and treat its varied neuropsychiatric symptoms. In this Review, we address key issues so that the psychiatric clinician can better understand and treat patients with a clinical phenotype that might be the direct result of, or be exacerbated by, concussion. Future research needs to focus on prospective clinical trials in all affected patient populations (ie, those affected by concussion and those affected by various degrees of traumatic brain injury), the identification of reliable biomarkers that can be used to assist with diagnosis and treatment response, and the development of effective treatment interventions. Clearly differentiating concussion from traumatic brain injury is essential to achieve reliable and clinically relevant outcomes.

Psychopharmacologic Management in Integrated Care: Challenges for Residency Education.

The integration of psychiatric care in primary care is becoming a reality. Psychiatric training programs are facing multiple challenges to accommodate this transition. We here present the perspectives of Group for the Advancement of Psychiatry Committee on Psychopharmacology. The members of the group respond to the concerns raised by a resident currently confronting this changing landscape. By discussing the training, clinical, and communicating challenges of integrated care, they shed light on many of the questions being tackled by residency training programs. This commentary on the timely discussion about integrated care seeks to provide insight on the future of training in psychiatry by outlining the core questions of this change.

The importance of understanding the psychological meaning of Angelina Jolie's surgery.

The recent announcement by the high profile actress, Angelina Jolie, that she had had a preventive double mastectomy because she had a high genetic risk of breast and ovarian cancer will lead other women who are at risk to consider similar operations. Psychiatrists and other physicians are likely to be asked to advise women concerning this decision. This column discusses the psychological impact of mastectomy and breast reconstruction for women and encourages clinicians to have an empathic and understanding attitude and allow patients to talk openly about their fears, doubts, concerns about sexual intimacy, and other issues. It is also important to let women experiencing psychological reactions to mastectomy know that such feelings are normal and usually recede in time.

Teaching psychodynamic psychotherapy in the 21st century.

Special challenges face the 21st century teacher of psychodynamic psychotherapy. Time for careful psychodynamic reflection, of necessity, competes for space with the current explosion of psychiatric knowledge in psychopharmacology, genetics, health care policy and multiple other agendas. Thus educators must be clear about the goals of psychodynamic psychotherapy, engage students in the special interviewing techniques to elicit sensitive information and appreciate the special needs of today's physicians launching into this field. Educational objectives must be clear, the goals of psychoanalysis and psychoanalytic psychotherapy well articulated and the means to gather information enhanced. With the expansion of neuroscience into the mysteries of implicit and explicit memory this is also an area where the 21st century educator must develop integrative expertise. There are tools available to expand ones proficiency in each of these areas.