August 2010  << Back  

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Where we are and where we need to be: Keeping our focus on clinical practice



I begin this editorial with the sad news that Dr. Elizabeth Weller passed away last year (her obituary). She was a long-time member of the American Academy of Clinical Psychiatrists (AACP) and an exceptional member of Annals of Clinical Psychiatry’s editorial board. I had the privilege of knowing Dr. Weller, and she will be greatly missed.

I want to call Annals readers’ attention to Dr. Henry A. Nasrallah’s editorial in the April 2010 issue of Current Psychiatry.1 His “manifesto” is one of the best summaries of the role and function of modern psychiatry that I’ve seen, although much of it will not be controversial to this audience. His “living document” proposes that psychiatry is a “medical specialty that focuses on brain disorders or behavior, thought, mood, cognition, and conation” and that psychiatrists must be “fully trained physicians.” Further, he acknowledges our shortcomings—including the inconvenient facts that diagnoses are more reliable than valid and that many of our treatments are based on serendipity. His manifesto is worth reading.

In this issue, we have a great collection of articles. We begin with a review by Annals board member Subramoniam Madhusoodanan, MD, and colleagues on extrapyramidal symptoms (EPS) associated with antidepressants. Most of us learn that EPS only develop with antipsychotic use, but their review reminds us that these symptoms sometimes occur with antidepressants. After more than 50 years of antidepressant usage, we still know little about response predictions, but Amy Farabaugh, PhD, and colleagues help fill this gap by showing that early improvement in anger/hostility helps predict treatment response. In this vein, my colleague Jess G. Fiedorowicz, MD, MS, and coworkers look at neuroticism as a predictor of response to escitalopram. Maren Nyer, MEd, and colleagues discuss the positive role that marriage has for enhancing quality of life for patients with schizophrenia/schizoaffective disorder, and show once again the power of intimate relationships for maintaining mental health. Roy R. Reeves, DO, PhD, and his group discuss unrecognized physical symptoms prompting psychiatric admission, alerting us to the need to be vigilant when assessing a patient’s physical status. In a timely communication, Phebe Tucker, MD, and colleagues find high cortisol levels in survivors of the 1995 Oklahoma City bombing with posttraumatic stress disorder, showing the power that traumatic events have on the long-term course of stress systems. Continuing their series of articles on attention-deficit/hyperactivity disorder (ADHD) that began in the May 2010 issue of Annals, Barrie K. Marchant, MS, and colleagues show that personality disorder symptoms interfere with response to OROS methylphenidate in adults with ADHD. Rounding out the issue, Adrian Palominao, MD, and colleagues present 2 case reports of reversible leukocytosis after lithium and clozapine combination therapy.

We are in the early stages of planning the next joint AACP/Current Psychiatry meeting set for April 2011 in Chicago, IL, with the theme of psychotic and cognitive disorders. Both organizations are committed to educating psychiatrists through stimulating and thought-provoking meetings. We will keep Annals readers informed of the meeting as planning proceeds.

Donald W. Black, MD


  1. BlackDW.A psychiatric manifesto. Current Psychiatry.2010;9:78.