57: Treating ‘Morally Objectionable’ Patients

Amir Inamdar MBBS, DNB (Psych), MFPM

Scare tactics don’t work. But scientific education might. Here are tips for talking with teenaged patients about keeping themselves and their friends safe. 

Last month we taught you how evening light can worsen mood. Today, we teach you how to fix that.

[Note: this is the second half of the Psych Pearls interview with James L. Knoll IV, MD. In the first half of the conversation, Knoll discussed the challenges of treating patients with traits like psychopathy or anti-social personality disorders. – Ed]  Forensic psychiatrists have emotionally taxing jobs: They spend countless hours studying acts of violence and the individuals who commit them. How could anyone endure this job for more than a few years?  James L. Knoll IV, MD, has survived decades in the field. In this edition of Psych Pearls, Knoll talks about how he maintains his mental well-being. He also reveals the childhood obsession that set him on his career path, reflects on how forensic psychiatry has changed over time, and looks forward to how it might change for the better in the future.   In this conversation, Psychiatric Times and Knoll cover: 1.     His childhood fascination with the Jonestown murder-suicide. 2.     How he got interested in forensic psychiatry.  3.     The risk of burnout in forensic psychiatry (or any other psychiatric specialty). 4.     How the arts and other creative endeavors can help psychiatrists stay mentally and physically well.  5.     The tension at the heart of the forensic psychiatrist’s identity: are they primarily treaters of mental illnesses, or expert witnesses?  6.     The new importance of social media for forensic investigations.  7.     Why it’s important not to judge patients—no matter how difficult they may be. Dr Knoll is professor of psychiatry and director of forensic psychiatry at SUNY Upstate Medical University in Syracuse, New York, and clinical director of Central New York Psychiatric Center in Marcy, New York. He is Emeritus Editor-in-Chief of the Psychiatric Times and President-elect of the American Academy of Psychiatry and the Law (2022-23).

Psychiatrists are not strangers to difficult and even potentially dangerous patients, but James L. Knoll IV, MD, has made these populations one of his specialties. With decades of experience in forensic psychiatry, Knoll takes listeners deep into the US criminal justice system, where he treats both inmates suffering from detention-related psychiatric disorders and an especially challenging group that he has dubbed morally objectionable patients.  In this conversation, Psychiatric Times and Knoll cover: 1.     What he means by the term morally objectionable patients.  2.     How prisons’ strict social hierarchies can contribute to psychiatric illnesses.  3.     The high prevalence of bipolar disorder and schizophrenia in corrections—and their potential causes.  4.     The different challenges of treating patients in prisons vs jails.  5.     Why inmates with psychiatric illnesses end up in the correctional system for longer than those without psychiatric illnesses. 6.     The role of mental health courts in improving psychiatric care in the correctional system. 7.     The challenges of treating patients who are high in psychopathy or have anti-social personality disorders.   This is the first half of the Psych Pearls podcast with Dr Knoll. Stay tuned for the second half later in the week.  Dr Knoll is professor of psychiatry and director of forensic psychiatry at SUNY Upstate Medical University in Syracuse, New York, and clinical director of Central New York Psychiatric Center in Marcy, New York. He is Emeritus Editor-in-Chief of the Psychiatric Times and President-elect of the American Academy of Psychiatry and the Law (2022-23).

In this edition of PsychPearls, Hannah Simon, MD, introduces a new series on teen and tween mental health. Her first guest is Andrew Chen, MD, MS, the chief medical officer for USA Nordic, the national leadership organization for Nordic Combined and Ski Jumping in the United States. They discuss the importance of mental wellbeing for peak athletic performance, the programs available for Olympic athletes, and how health care providers can help students succeed—in everything from the big game to the big test.   In this podcast they cover: - Dr Chen’s path from medical school to the Olympic Games - Simone Biles and fighting the stigma surrounding mental illness - The mental health challenges facing school-aged children during the pandemic - The importance of diet and nutrition for athletic performance and mental wellbeing - 5 personality attributes that Olympians share (and what psychiatrists can learn from them) Dr Simon is a child and adolescent psychiatry fellow at New York-Presbyterian Hospital.  Acknowledgement: Thanks to Columbia University Department of Psychiatry for allowing us to present the Caring for Teens and Tweens podcast with experts in the field of psychiatry.

Lamotrigine was launched for bipolar disorder in 2003, but it was a quiet launch, and since then a few myths have gathered around it as if to fill that vacuum. Today, we will address 4 of them. 

Blue light is getting blamed for everything from eye strain to cancer lately, but what does it do to our patients with depression and bipolar disorder. A lot, as you will see in this podcast, but it depends on what time of day it is shining.

PSYCHPEARLS PODCAST Alzheimer disease (AD) remains one of the most dreaded diagnoses a patient can get. The US Food and Drug Administration (FDA) raised hopes when it approved aducanumab, which promised to be the first disease-modifying drug for AD. But the approval immediately proved controversial. Three FDA board members resigned, the FDA then narrowed its patient label, and in mid-July, major hospitals announced that they would not administer the drug.  In this edition of Psych Pearls, Helen Lavretsky, MD, MS clarifies the issues in the aducanumab debate and offers guidance for clinicians whose patients may ask about it. Going beyond pharmacology, she points out that other treatment options, including mind-body interventions and diet changes, have been shown to slow AD’s progression.  In this conversation, Psychiatric Times and Lavretsky cover: 1.     The aducanumab controversy 2.     Advice for talking to patients and caregivers about aducanumab and other novel pharmacological options 3.     Mind-body and lifestyle interventions for AD 4.     AD prevention programs, including nutrition, exercise, and stress reduction 5.     Taking care of caregivers, including psychiatrists and other medical professionals 6.     How to prescribe joy  Dr Lavretsky is a professor in-residence in the Department of Psychiatry at the University of California, Los Angeles. Her work on geriatric depression and integrative mental health using mind-body interventions has received national attention, and she has won numerous grants supporting that work. A distinguished fellow of the American Psychiatric Association and a fellow of the American College of Neuropsychopharmacology, she is also on the board of Psychiatric Times.