From the June 28, The New York Times, Seeking to pre-empt marital strife.

One federally financed study is tracking 217 couples taking part in an annual “marriage checkup” that essentially offers preventive care, like an annual physical or a dental exam.

“You don’t wait to see the dentist until something hurts — you go for checkups on a regular basis,” said James V. Córdova, an associate professor of psychology at Clark University in Worcester, Mass., who wrote “The Marriage Checkup” (Jason Aronson, 2009). “That’s the model we’re testing. If people were to bring their marriages in for a checkup on an annual basis, would that provide the same sort of benefit that a physical health checkup would provide?”

From the June 29, Wall Street Journal, Worried About a Moody Team?

Warning signs:

Dr. Diamond says sulks or doldrums that persist for two or more weeks could be a sign of depression and should be taken seriously.

Parents should pay attention to how a teen is functioning in school, sports, favorite activities, a job and with friends.

This article recommends consulting first with the teen’s pediatrician, someone who already has a relationship with the family. (Perhaps killing 2 birds with one stone: your insurance provider may require a referral to a psychiatrist anyway.)

From the July 1, USA Today, Of Medical Specialties, demand for Psychiatrist is Highest.

From April 2009 to March 2010, the company Merritt Hawkins received 179 requests for psychiatrists — a 47% increase from the previous year and 121% increase from the 2006-2007 survey.

The firm, which tracked more than 2,800 physician requests, found that psychiatrists were the third-most-requested physician.

Though demand is growing, fewer medical students are entering careers in psychiatry. Health officials say the field garners little interest because psychiatrists earn less than other specialties, even though they spend the same amount of time in medical training.

Thanks to Lauren for finding these articles.

From The Lancet Mental Health Themed Issue, August 22, 2009:

David Kessler and colleagues evaluate the acceptability and clinical effectiveness of an internet-based psychotherapy programme for depression. Nearly two-thirds of those offered the programme completed five or more therapy sessions, a substantially higher rate than we would expect with in-person therapy. Clinical benefits were larger than generally seen with computerised self-help programmes, and similar to those with traditional in-person psychotherapy.

Listen to the podcast (interview starts at 1:20):

The researcher was asked why they didn’t use video/voice in the internet-delivered therapy and relied on text. He posed a very interesting question in response: what about writing made it so effective? Writing requires pausing/reflection/editing which is different than talking. There is also evidence that writing, as a therapy, helps recovery from trauma. And finally, these questions of “eye contact” and “body language / mood congruency” and “anonymity” … have not been adequately tested yet to demonstrate that a therapist and patient, face to face, is necessarily the best setting for all people, for all therapies.

As discussed in other blogs, the DSM-5 is under review and generates a lot of controversy. This American Life does a great job, using the example of homosexuality, to show how and why definitions of mental disorders change over time. Reflecting not just changes in scientific understanding, but also social, political, and personal pressure. That those pressures exist, and have impact, doesn’t invalidate the DSM.

January 18, 2002 podcast of This American Life. Listen here.

In 1973, the American Psychiatric Association (APA) declared that homosexuality was not a disease simply by changing the 81-word definition of sexual deviance in its own reference manual. It was a change that attracted a lot of attention at the time, but the story of what led up to that change is one that we hear today, from reporter Alix Spiegel. Part one of Alix’s story details the activities of a closeted group of gay psychiatrists within the APA who met in secret and called themselves the GAYPA … and another, even more secret group of gay psychiatrists among the political echelons of the APA. Alix’s own grandfather was among these psychiatrists, and the president-elect of the APA at the time of the change. Alix Spiegel’s story continues, with a man dressed in a Nixon mask called Dr. Anonymous, and a pivotal encounter in a Hawaiian bar.

The 1968 definition at the time was a step forward, defining homosexuality as a disease instead of a moral decision.

The new 1973 definition:

302.0 Sexual orientation disturbance (Homosexuality)
This category is for individuals whose sexual interests are directed primarily toward people of the same sex and who are either disturbed by, in conflict with, or wish to change their sexual orientation. This diagnostic category is distinguished from homosexuality, which by itself does not constitute a psychiatric disorder. Homosexuality per se is one form of sexual behavior and, like other forms of sexual behavior which are not by themselves psychiatric disorders, is not listed in this nomenclature of mental disorders.

If the patient had subjective distress it was a disorder. If it didn’t bother you, you weren’t sick.

The current DSM deletes the definition; it is not a disorder. It is now ethically wrong for psychiatrists or psychologists to treat it as such.