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]

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January 25, 2015

This week a commentary, written by members of the University of Pennsylvania Department of Medical Ethics and Health Policy and titled “Improving Long-term Psychiatric Care: Bring Back the Asylum” was published in JAMA Online. The authors recommend a return to asylum care, albeit not as a replacement for but as an addition to improved community services and only for those who have “severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community based treatment.” The authors seem to accept the notion of transinstitutionalization (TI) which suggests that people who in another generation would have lived in state hospitals are now incarcerated in jails and prisons. While I do not agree, I do find there is a need for a safe place for people to stay while they work through their crisis.
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Categorized in: Blogs, Coercion, Community, Featured Blogs, Involuntary Treatment, Legislation & Regulation, Non-drug Approaches, Police Interventions, Rethinking Psychiatry/Medical Model, Uncategorized

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January 9, 2015

Atul Gawande is a physician author whose work has been published in The New Yorker, among other places. In his most recent book, Being Mortal, he explores the complexity of end of life care. In this blog I discuss why I found this book relevant to Mad In America.
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December 25, 2014

This week, MIA featured a news item regarding a recent “proof of concept” study conducted at Washington University of St. Louis to investigate whether nitrous oxide, commonly known as laughing gas, was effective in reducing symptoms of depression. Why is this a problem?
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December 2, 2014

This week we launch Mad In America Continuing Education. It is an enormous privilege to be a part of this project and to proudly announce that the first course offering is a series of lectures by me on neuroleptic drugs. I review the history of the development of these drugs as well as their short and long term effects. I discuss what conclusions I have drawn from the data; I recommend that we need to work harder to keep people off these drugs or – if we use them – to minimize the dose and stop them as soon as possible. But there remain other pressing concerns for those individuals who are currently taking these drugs.
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Categorized in: Antipsychotics, Blogs, Featured Blogs, Medication Tapering/Withdrawal, Popular, Psychiatric Drugs, Uncategorized

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October 14, 2014

I was honored to both attend and participate in the recent Mad In America Film Festival. I was asked to join a panel of psychiatrists who were asked to respond to the themes and questions explored in the festival. What follows are a lightly edited version of my remarks.
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Categorized in: Blogs, Featured Blogs, Popular, Rethinking Psychiatry/Medical Model, Uncategorized

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September 29, 2014

In a couple of weeks, I may see some of you at the MIA Film Festival. I am honored to be on a panel called “Re-Thinking Psychiatry” with two esteemed colleagues. In advance of the festival, I decided to write about what has been most central in my own “re-thinking”: my basic understanding of psychosis – when a person does not share consensual reality. It has been a fundamental re-think: how do we define it? how do we understand it? when do we intervene? how do we intervene?
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Categorized in: Blogs, Featured Blogs, Medication Tapering/Withdrawal, Popular, Psychiatric Drugs, Uncategorized

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July 28, 2014

From time to time, I find myself feeling the urge to articulate my views and delineate them from people with whom I may be identified. Rightly or wrongly, I feel that way with this website. Although the goal is to have wide ranging goals there is nevertheless a distinct perspective represented here. I feel the urge to articulate where I part ways with some of the views expressed here. I do this in the spirit of discourse. I am not certain I am correct. I may someday change my mind. I am just expressing my perspective.
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July 4, 2014

The talk explains my own evolution as a psychiatrist and addresses the development of the Critical Psychiatry Network.  I focus on three main areas: psychiatric diagnosis, the influence of the commercial forces of the pharmaceutical industry on medicine in general and psychiatry in particular, and the evolution of the use of neuroleptic drugs (in that order).
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May 7, 2014

I recently had the great pleasure of hosting a Hearing Voices workshop with Ron Coleman and Karen Taylor. The response was overwhelmingly positive. Many people described this as one of the best trainings they had ever attended. Ron’s message is inherently uplifting – after all this internationally known educator was once a mental patient given a poor prognosis. But in addition, they offered pragmatic suggestions for how to think about voices and talk to someone who is experiencing them.
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Categorized in: Adult, Blogs, Community, Disorders, Featured Blogs, Hearing Voices, Non-drug Approaches, Recovery/Empowerment, Uncategorized

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April 20, 2014

People are very confused about what psychiatry is. Psychiatry is a bit confused. Collapsing psychiatry into neurology would be clearer. If you want an evaluation to understand possible medical causes of your problem go to the nerve doctor. If you want to know if there is a pill for you, go to the nerve doctor. If you want to understand your experience as a human and the nature of your suffering, leave medicine out of it.
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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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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, Popular, Psychiatric Drugs, Research, Uncategorized

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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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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 and Psychosis, Uncategorized

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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, Popular, Psychiatric Drugs, Research

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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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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 and Psychosis, Uncategorized

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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

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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 and Psychosis, Trauma/Distress, Uncategorized

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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 and Psychosis

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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 and Psychosis

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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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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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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 and Psychosis

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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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