ANATOMY OF A PSYCHIATRIC PRACTICE

Sandra Steingard, M.D. is the Medical Director of HowardCenter and Clinical Associate Professor of Psychiatry at the University of Vermont College of Medicine in Burlington.  She was educated and trained at Harvard and Tufts Universities in Boston and received her specialty certification in psychiatry from the American Board of Psychiatry and Neurology in 1986.

Her areas of interest include community mental health and the diagnosis and management of psychotic illnesses.  She was named an Exemplary Psychiatrist by the National Alliance for the Mentally Ill of Vermont in 1996, and has been listed in the Best Doctors in America since 2003. She can be reached at: [email protected]

Sandra Steingard, M.D. Advice to the Newbies: Give Your Heart, & Hold Your Theories Lightly

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April 6, 2014

I was recently asked to give the commencement address for Goddard College’s masters program in psychology and counseling. This is what I said.
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Sandra Steingard, M.D. Are Neuroleptics “Anti-Psychotic”? Harrow’s 20-Year Outcomes

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March 29, 2014

Martin Harrow along with his colleagues T.H. Jobe and R. N. Faull has published another paper on the long term outcome of people who experienced a psychotic episode. Funded by a grant from the Foundation for Excellence in Mental Health Care, this paper adds to our knowledge of an extremely important and valuable study.
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Categorized in: Antipsychotics, Blogs, Coercion, Featured Blogs, Psychiatric Drugs, Research, Uncategorized

Sandra Steingard, M.D. Do We Need to See Inside the Box?

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March 9, 2014

This week, Dr. Insel announced new guidelines for NIMH-funded research that will require clinical studies to link to an underlying brain mechanism. This is a response to psychiatry’s poor track record thus far. I do not think this will solve the problem.
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Sandra Steingard, M.D. A New Silver Bullet? The Lurasidone Story

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February 17, 2014

Recently, I have been the target of much wooing by my local Sunovion rep. I think he leaves messages for me almost weekly and he sends me missives – glossy brochures and reprints from major psychiatric journal. What is the subject of this attention? The drug – lurasidone (Latuda).
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Categorized in: Adult, Antidepressants, Antipsychotics, Blogs, Depression, Disorders, Featured Blogs, Psychiatric Drugs, Schizophrenia/Psychotic Disorders, Uncategorized

Sandra Steingard, M.D. Paradigm Shift

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February 9, 2014

An important study was headlined on MIA this week. The study examined the effectiveness of cognitive behavioral therapy (CBT) to treat the symptoms of people labeled with a diagnosis of schizophrenia and related conditions who had elected to not take neuroleptic drugs.
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Categorized in: Antipsychotics, Blogs, Featured Blogs, Psychiatric Drugs, Research

Sandra Steingard, M.D. Conflict of Interest, DSM-5, and the APA

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January 25, 2014

The point of this post is to bring your attention to the writings of some fellow bloggers, particularly 1 Boring Old Man (1BOM). For the past 6 months , but particularly in the past month, he has brought attention to a conflict of interest with David Kupfer, the head of the APA’s DSM-5 task force.
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Sandra Steingard, M.D. American Psychosis

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November 25, 2013

E. Fuller Torrey has a new book. While I was not thrilled to support the Treatment Advocacy Center, I was curious as to what he had to say. Where Torrey has clarity, I contend there is much that we still do not understand. I worry that a perspective that suggests the answers are clear cuts us off from inquiry into alternate approaches.
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Categorized in: Adult, Blogs, Disorders, Featured Blogs, Industry, Schizophrenia/Psychotic Disorders, Uncategorized

Sandra Steingard, M.D. Tapering Neuroleptics: Two Year Results

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November 18, 2013

A colleague and I have been tracking individuals who elect to reduce their dose of neuroleptic drug. The two year results are presented here.
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Categorized in: Antipsychotics, Blogs, Featured Blogs, Psychiatric Drugs, Uncategorized

Sandra Steingard, M.D. I Wonder if There is Some Axis II Going on Here? Further Thoughts on Muddled Thinking

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November 3, 2013

This blog was prompted by an invitation to do a guest post on the site of one of my favorite bloggers, 1 Boring Old Man. This is my response to the notion that there are certain conditions – Schizophrenia among them – that correspond more directly to biomedical conditions
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Categorized in: Adult, Anxiety, Bipolar, Blogs, Depression, Disorders, Hearing Voices, Non-Drug Approaches, Personality Disorders, Schizophrenia/Psychotic Disorders, Trauma/Distress, Uncategorized

Sandra Steingard, M.D. “Why Wunderink Matters”

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October 8, 2013

Sandra Steingard writes in Community Psychiatrist about Lex Wunderink’s study, published in the August JAMA Psychiatry, which found that people who discontinued medication have much higher rates of functional remission and full recovery. She also notes the work of Martin …
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Categorized in: Adult, Antipsychotics, Around The Web, Blogs, Disorders, Non-Drug Approaches, Psychiatric Drugs, Recovery/Empowerment, Research, Schizophrenia/Psychotic Disorders

Sandra Steingard, M.D. Taking “Anti-Psychotics”
When You Are Not Psychotic

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September 9, 2013

The Wunderink study has been discussed here in other blogs. In brief, using a randomized control design, Wunderink found that in adults diagnosed with a psychotic disorder continuous use of neuroleptics was associated with worse functional outcomes. Is this study relevant to those who do not experience psychosis?
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Categorized in: Adult, Antipsychotics, Blogs, Disorders, Featured Blogs, Psychiatric Drugs, Schizophrenia/Psychotic Disorders

Sandra Steingard, M.D. Can Psychiatry “Re-Engage” with Pharma?

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August 4, 2013

On August 1, Jeffrey Lieberman the current President of the American Psychiatric Association wrote an open letter to Psychiatry News asking whether is was time for psychiatry to “re-engage with pharma.” Dr. Lieberman’s essay seems short on acknowledging any personal or collective responsibility for the problems that arose in our profession’s interactions with the pharmaceutical industry.
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Sandra Steingard, M.D. Haloperidol is Neurotoxic

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July 21, 2013

This is the headline of an editorial in the most recent edition of Current Psychiatry. It is written by a prominent psychiatric researcher. Read more on why I am not so comfortable with his suggested solution.
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Sandra Steingard, M.D. A Paradox Revealed – Again

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July 7, 2013

In this blog, I discuss three RCTs that support Martin Harrow’s findings in his naturalistic study that long term use of neuroleptics is associated with worse functional outcomes.
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Categorized in: Adult, Blogs, Disorders, Featured Blogs, Schizophrenia/Psychotic Disorders

Sandra Steingard, M.D. I Am Also Mad

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June 26, 2013

Today I read Psychiatric News, the newspaper of the American Psychiatric Association, and I was drawn to an article about the new APA President, Jeffrey Lieberman, because the front page teaser announced that “he is ‘mad as hell’”.
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Sandra Steingard, M.D. Failures of the Medical Model

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June 2, 2013

Saying we do not like the medical model will not make that model go away. I do not think we resolve these problems simply by declaring that emotional distress is not a medical concern.
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Sandra Steingard, M.D. Thoughts on the Meaning of Neuroscience

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May 19, 2013

For me there are at least four separate questions to be addressed. The first is whether neuroscience is capable of understanding human emotion and higher level cognitive experiences. The second is the extent to which that understanding – even if it is achievable – is critical to our being able to help people in distress. The third is whether is it is correct to assume, as many people seem to do, that if we come to some basic understanding of brain function as it pertains to core human emotion and suffering that this will automatically translate into treatments that are commonly thought of as “biological,” such as drug treatment. The fourth relates to the limitations and relevance of studying the brain in isolation when we are constantly in interaction with our environment.
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Categorized in: Blogs, Featured Blogs, Neuroscience, Uncategorized

Sandra Steingard, M.D. Why I Won’t Buy the DSM-5

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May 13, 2013

As the medical director of a community mental health center, my colleagues look to me for guidance on how to approach the new edition of the DSM. How many should we buy? How much time should be devoted to staff training? This is my answer.
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Categorized in: Blogs, DSM, Featured Blogs

Sandra Steingard, M.D. All Sorts of Realities

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April 22, 2013

In previous posts in this series, I noted that the standard treatment of conditions labeled as schizophrenia (and related disorders) is to start neuroleptics early and to continue them indefinitely. This is based on the belief that untreated psychosis is bad for the brain and that relapse is much higher when the drugs are stopped than when they are continued. The rationale for this approach, and my discussion of the limitations of these assertions, were the topics of previous blogs in this series. In this final post I want to discuss how realistic this paradigm of care is.
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Categorized in: Antipsychotics, Blogs, Featured Blogs, Psychiatric Drugs

Sandra Steingard, M.D. Optimal Use of Neuroleptics, Part 3: Duration of Untreated Psychosis

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April 14, 2013

For the past 20 years, there has been a prevailing concern in psychiatry that psychosis is bad for the brain. When I read Anatomy of an Epidemic, this was one of my most pressing concerns; if I suggested to my patients that they pursue other treatments before starting drug treatment, was I helping or harming them?
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Categorized in: Adult, Antipsychotics, Blogs, Disorders, Featured Blogs, Psychiatric Drugs, Research, Schizophrenia/Psychotic Disorders

Sandra Steingard, M.D. Optimal Use of Neuroleptics, Pt. II; The Monkeys Were Not Psychotic

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March 30, 2013

A major research group mentions in a paper published in an academically rigorous psychiatric journal (and I get it that some readers consider that an oxymoron) the possible influence of super-sensitivity on increasing the risk of relapse when neuroleptic drugs are stopped. Yet those of us who raise this as a reason to moderate our use of these drugs are considered biased or scientifically naive.

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Categorized in: Antipsychotics, Blogs, Featured Blogs, Psychiatric Drugs

Sandra Steingard, M.D. Optimal Use of Neuroleptic Drugs: An Introduction

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March 23, 2013

This post and the ones to follow will summarize my current thinking on the optimal use of neuroleptic drugs.
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Sandra Steingard, M.D. How You Have Changed Me

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January 1, 2013

It has been a year this since the Mad In America website launched and I posted my first blog. You have been a smart and well informed audience. I know that many of you are eager to change the mental health system; for what it is worth, you have changed one doctor.
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Sandra Steingard, M.D. A Recent Study of Atypical Neuroleptics: “The Results of our Study are Sobering”

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December 3, 2012

This week, MIA highlighted a recently published study of the four most commonly prescribed neurolpetics. As noted in the post, the major outcome was that these drugs were not found to be effective or safe. This important study, co-authored by Dilip Jeste the current president of the American Psychiatric Association, is worth reviewing in greater detail.
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Categorized in: Antipsychotics, Blogs, Featured Blogs, Psychiatric Drugs, Uncategorized

Sandra Steingard, M.D. See What You Want to See

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November 12, 2012

(August, 1985) My first academic article, entitled, “Dissociation and Psychotic Symptoms” is published in The American Journal of Psychiatry. It was a case report of a young girl who experienced visions and voices. We thought that she had dissociative symptoms and we had taught her how to control these experiences through self hypnosis. In the same month, an article was published in another academic journal. This was entitled, “Treatment of Bulimia and Rapid-Cycling Bipolar Disorder with Sodium Valproate: A case Report .” We were describing the same young girl. Our treatments were concurrent. How could this be?
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