Health financing: challenges and opportunities, coverage and cost

This policy panel will present and debate proposals for the next steps in reforming the U.S. health care system. Which challenge deserves the highest priority – providing universal access; instituting better measures of quality and outcomes and better management systems; or reining in costs? How should these challenges be addressed? What keeps us from “having it all”? Does the fundamental obstacle lie in market behavior, inadequate or asymmetric information, lack of political will, or the human psyche? How would the proposed reforms tackle the underlying issue and help us maintain a sustainable balance between health care access, quality and cost – and between our health care goals and other important policy objectives – in future years?Health care reform

The Use of Carbamazepine (Tegretol) in Psychiatry and Its Association to Kindling, Temporal Lobe Epilepsy and Psychopathology

The recent theory of kindling may help to link neurophysiologic, neurotransmitter and neuroanatomic mechanisms important in understanding the neurology of behavior. Limbic kindling is of interest in developing models of epilepsy, psychosis, learning and memory (l -5). Kindling might explain the late development of psychopathology. This paper will first define kindling and demonstrate how kindling offers a model within which to view more prolonged behavioral deviations as neurophysiological processes. The use of carbamazepine and its association to kindling, temporal lobe dysfunction and psychopathology will be discussed

The Management of Performance Anxiety with Beta-Adrenergic Blocking Agents

Performance anxiety consists of several symptoms experienced in the context of public performance and is classified in DSM-III-R under social phobia. Performance anxiety must be distinguished from panic disorder, generalized social phobia, and generalized anxiety disorder. Performance anxiety symptoms can be detrimental to both performer and performance. These symptoms can be controlled by the judicious use of beta-adrenergic blocking agents. The use of beta-adrenergic blocking agents should be considered as part of a psychiatric stress-management program for these patients

The Relevance of Transference during Medication Management: A Case of Erotized Transference

Forces existing in psychiatry may diminish the importance of psychotherapy training as psychiatrists are increasingly given the task of medication management. Psychotherapeutic relationships can be created in medication management settings, however, and the neglect of concepts such as transference could have deleterious consequences. The authors describe the case of a man with a traumatic brain injury referred for medication management who developed an erotized transference toward his female resident-physician. This case illustrates the concept that an understanding of transference is relevant to the setting of medication managemen

Sexual Predators: Mental Illness or Abnormality? A Psychiatrist\u27s Perspective

In this Symposium Article, the author discusses Washington’s Sexually Violent Predator Act, RCW 71.09.060, from a psychiatrist’s perspective

Keynote Address: Why Are There so Many Injuries to Our Young Athletes? Professionalization and Specialization in Youth Sport

Keynote address at the Amateur Sports Symposium: Death of Amateurism: Implications for Sport and Health, delivered at the University of Baltimore School of Law on Thursday, October 28, 201

Dependent Parents’ Pension Claim for a Killed Maine Soldier: The Case of Emeline and William Merrill, 1880-1887

Dr. James A. Christian is a practicing internal medicine physician. He holds an undergraduate degree from Harvard College and a M.D. degree from the University of Texas Southwestern Medical School. For the past fifteen years, Dr. Christian has served as a lead physician in a medical group that provides staffing for Federal Occupational Health Clinics in the metropolitan Washington, D.C., area. He resides in Silver Spring, Maryland. Dr. Christian has a particular interest in how new historical scholarship can help in more accurately understanding and appreciating the pervasive suffering that accompanied the Civil War

Clozapine, Fluoxetine, and Benztropine- associated Ileus: Case Report

Gastrointestinal complications of anticholinergic medications are prevalent, potentially life-threatening, and could be more actively prevented. We present a case report of an ileus that required surgical intervention and developed in the context of clozapine, benztropine, and fluoxetine use. The case exemplifies the potential anticholinergic toxicities of clozapine and benztropine as well as possible pharmacokinetic interactions between fluoxetine, clozapine, and benztropine. We discuss ways to minimize the likelihood of anticholinergic complications with these medications

Sexual Predators: Mental Illness or Abnormality? A Psychiatrist\u27s Perspective

In this Symposium Article, the author discusses Washington’s Sexually Violent Predator Act, RCW 71.09.060, from a psychiatrist’s perspective