Category Archives: First Comments

What does hypomania look like?

Hypomanic states are rarely observed by the psychiatric clinician. Bipolar  patients are much more commonly depressed  (according to Judd et al, bipolar II patients spent only 1.3% of the time in hypomania over 13 years of follow-up). http://jamanetwork.com/journals/jamapsychiatry/fullarticle/207252  accessed 1/14/17 … Continue reading

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Trans-Atlantic differences on drinking in pregnancy, and the pleasures of literary fiction

The English have a somewhat more relaxed attitude towards drinking in pregnancy than we do in the States. From the RCOG: “It is recommended that you do not drink alcohol during the first three months of pregnancy. Drinking small amounts … Continue reading

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How long to give an SSRI to work ?

An important review article and meta-analysis, Early Treatment Responses of Selective Serotonin Reuptake Inhibitors (SSRIs) and clomipramine in pediatric OCD was published in the Journal of the American Academy of Child and Adolescent Psychiatry (October, 2016, p 851-859). http://www.jaacap.com/article/S0890-8567(16)31160-1/fulltext   The … Continue reading

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J shaped risk curves versus linear risk curves: drinking versus smoking

Too often, when I ask patients if they smoke cigarettes, I hear, “Oh, only 2 or 3 a day”, as if, not a problem, no big deal, like saying, “when I play Russian roulette, there’s only one bullet in the … Continue reading

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Thinking about sleep: Maiken Nedergaard and the function of deep sleep

All animals sleep, even flies (research with the fruit fly Drosophila revealed the presence of clock genes).  All mammals have REM (rapid eye movement) and non-REM sleep. Human infants sleep 16 hours/day (if their parents are lucky); adults sleep 8 … Continue reading

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Can I bring my medications on vacation?

A patient emailed me recently: he was going to a few countries in Europe. Could he take his medications with him? He was on a schedule II stimulant. I think it’s a good idea, before visiting a new country, to … Continue reading

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On Is Adult ADHD a Childhood-Onset Neurodevelopmental Disorder? Evidence From a Four-Decade Longitudinal Cohort Study by T. E. Moffitt et al. Published online: May 22, 2015 http://dx.doi.org/10.1176/appi.ajp.2015.14101266

This surprising  article will probably  change the way clinicians view and assess adult ADHD and the way DSM-6 conceptualizes it. DSM-5 considers ADHD a “neurodevelopmental disorder” (page 32) and states that “ADHD begins in childhood” (page 61). Diagnostic Criterion B … Continue reading

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Proper Artistic Attitude

In order to analyze Davis’ fresh approach to the translation, I would like to compare her work in a famous passage from the novel …. The passage ends with a beautiful and often quoted simile in which Flaubert compares human … Continue reading

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Proper scientific attitude

“I do not know what I may appear to the world, but to myself I seem to have been only like a boy playing on the sea-shore, and diverting myself in now and then finding a smoother pebble or a … Continue reading

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How to avoid paying too much for generic medications

The pricing of generic medications for uninsured patients is irrational and counter-intuitive. Because of this, the uninsured patient can pay far too much for a generic drug. One might expect that the price of a generic medication to be “low”, … Continue reading

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