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About this issue
About This Issue ELSEVIER
Nada L. Stotland, M.D., Editor-in-Chief
Welcome to the inaugural issue of Medical Updatefor Psychiatrists, the journal that keeps psychiatrists' general medical knowledge current and useful. The issue begins with an article by me, explaining the reasons for the development of the journal. Psychiatry is reclaiming its rightful place in the house of medicine, and psychiatrists need authoritative, clinically useful information about primary care and other medical specialties; information geared to the realities of their psychiatric work, whether in academia, private practice, organized care delivery settings, administration, or the public sector. Hypertension afflicts much of the adult population. Andrew Cutler, the journal's Assistant Editor, who is dually trained, in psychiatry and in internal medicine, has written an article to advise psychiatrists on screening their patient populations, identifying situations requiring urgent intervention, and assessing the hypertensive patient. Because many patients require medications for both hypertensive and psychiatric conditions, the article addresses drug-drng interactions, as well as psy-
chiatric side effects of antihypertensives and the effects of psychoactive medications on blood pressure. Adult, child and adolescent psychiatrists deal with patients suffering from nocturnal enuresis, and their families. The psychiatrist needs to know when nocturnal enuresis demands a medical or urological work-up, and what workup is indicated. Even when benign, this condition can be humiliating, socially crippling, disruptive, and divisive to the family. Armed with accurate information, the psychiatrist can assure appropriate medical intervention and reassure the worried family. Hysterectomy is one of the most common major surgical procedures performed in the United States. Many women psychiatric patients will have had, will have, or will consider, hysterectomy. Psychiatrists need to understand the latest in indications and surgical techniques. What are the implications of removing or preserving the ovaries? Must the procedure be performed through an abdominal incision? How long should it take the patient to recover? Should she expect changes in
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her sexual function? Hysterectomy is a highly emotionally charged procedure. Obesity is becoming an American epidemic. A major factor in general medical morbidity and mortality, it is a condition highly resistant to most forms of treatment. Obese patients suffer from significant emotional pain and social discrimination; patients with psychiatric disorders and obesity suffer from a double stigma. One option for obese patients is surgical alteration of the gastrointestinal tract. The psychiatrist will want to know what procedures can be performed, which patients are suitable for surgical intervention, what the complications are, and what outcomes can be expected. The mania of bipolar disorders can be life-threatening. What further complicates the clinical care is the fact that manic signs and symptoms can also be caused by general medical disorders. Psychiatrists, as the only healthcare professionals fully trained in both medicine and mental health, must be prepared to distinguish bipolar illness from these other conditions. Appropriate assessment and differential diagnosis will focus treatment and save lives.
Nada L. Stotland, M.D., Editor-in-Chief
Welcome to the inaugural issue of Medical Updatefor Psychiatrists, the journal that keeps psychiatrists' general medical knowledge current and useful. The issue begins with an article by me, explaining the reasons for the development of the journal. Psychiatry is reclaiming its rightful place in the house of medicine, and psychiatrists need authoritative, clinically useful information about primary care and other medical specialties; information geared to the realities of their psychiatric work, whether in academia, private practice, organized care delivery settings, administration, or the public sector. Hypertension afflicts much of the adult population. Andrew Cutler, the journal's Assistant Editor, who is dually trained, in psychiatry and in internal medicine, has written an article to advise psychiatrists on screening their patient populations, identifying situations requiring urgent intervention, and assessing the hypertensive patient. Because many patients require medications for both hypertensive and psychiatric conditions, the article addresses drug-drng interactions, as well as psy-
chiatric side effects of antihypertensives and the effects of psychoactive medications on blood pressure. Adult, child and adolescent psychiatrists deal with patients suffering from nocturnal enuresis, and their families. The psychiatrist needs to know when nocturnal enuresis demands a medical or urological work-up, and what workup is indicated. Even when benign, this condition can be humiliating, socially crippling, disruptive, and divisive to the family. Armed with accurate information, the psychiatrist can assure appropriate medical intervention and reassure the worried family. Hysterectomy is one of the most common major surgical procedures performed in the United States. Many women psychiatric patients will have had, will have, or will consider, hysterectomy. Psychiatrists need to understand the latest in indications and surgical techniques. What are the implications of removing or preserving the ovaries? Must the procedure be performed through an abdominal incision? How long should it take the patient to recover? Should she expect changes in
-I!
her sexual function? Hysterectomy is a highly emotionally charged procedure. Obesity is becoming an American epidemic. A major factor in general medical morbidity and mortality, it is a condition highly resistant to most forms of treatment. Obese patients suffer from significant emotional pain and social discrimination; patients with psychiatric disorders and obesity suffer from a double stigma. One option for obese patients is surgical alteration of the gastrointestinal tract. The psychiatrist will want to know what procedures can be performed, which patients are suitable for surgical intervention, what the complications are, and what outcomes can be expected. The mania of bipolar disorders can be life-threatening. What further complicates the clinical care is the fact that manic signs and symptoms can also be caused by general medical disorders. Psychiatrists, as the only healthcare professionals fully trained in both medicine and mental health, must be prepared to distinguish bipolar illness from these other conditions. Appropriate assessment and differential diagnosis will focus treatment and save lives.