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A philosopher argues there is an ethical imperative to provide psychotherapy to depressed patients because the insights gained from it promote autonomy. One in six people worldwide will experience depression over the course of a lifetime. Many who seek relief through the healthcare system are treated with antidepressant medication; in the United States, nearly 170 million prescriptions for antidepressants were written in 2005, resulting in more than $12 billion in sales. And yet despite the dominance of antidepressants in the marketplace and the consulting room, another treatment for depression has proven equally effective: psychotherapy—in particular, cognitive behavior therapy (CBT). Antidepressants can lift mood independent of a person's understanding of symptoms or stressors. By contrast, CBT teaches patients skills for dealing with distressing feelings, negative thoughts, and causal stressors. In The Ethical Treatment of Depression, Paul Biegler argues that the insights patients gain from the therapeutic process promote autonomy. He shows that depression is a disorder in which autonomy is routinely and extensively undermined and that physicians have a moral obligation to promote the autonomy of depressed patients. He concludes that medical practitioners have an ethical imperative to prescribe psychotherapy—CBT in particular—for depression. To make his case, Biegler draws on a wide philosophical literature relevant to autonomy and the emotions and makes a comprehensive survey of the latest research findings from the psychological sciences. Forcefully argued, densely researched, and engagingly written, the book issues a challenge to physicians who believe their duty of care to depressed patients is discharged by merely writing prescriptions for antidepressants.
Ketamine for Treatment-Resistant Depression: Neurobiology and Applications provides a simple, evidence-based overview for neuropsychiatrists and translational researchers on this medication, its mechanisms of actions, eligibility of patients for treatment, and the preparation and implementation of ketamine clinics. - Provides efficacy research on ketamine as a treatment for depression - Identifies best practices for clinical use, both long-term and acute - Discusses the molecular mechanisms and neurobiology of action
"This new edition of Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals thoroughly updates the highly regarded and groundbreaking first edition, offering the contemporary reader clinical wisdom and ethical guidance for challenging times. As with its predecessor, the second edition features commentaries by leaders in psychiatric ethics, plus two foundational chapters on ethics and professionalism in the field of mental health. These commentaries and introductory chapters provide an overview of essential ethical principles and concepts, the professional obligations of the mental health clinician, common ethical tensions found in practice, ethical aspects of caring for special populations, and ethical issues in professional training and research. The introductory chapters are followed by case-oriented questions and answers on core concepts and topics in clinical care, medical research, and interactions with colleagues and trainees. Topics explored in-depth include authorship, disclosure, and ethical peer review for scientific publications; assisted suicide and euthanasia; professional voyeurism versus patient privacy online and on social media; the appropriate process for reporting an impaired colleague; and problems of burnout, work-life balance, and professional well-being. Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals poses and plumbs critically important ethical dilemmas in a compelling, down-to-earth way for today's practitioners and learners"--
This book brings together an international group of clinicians and researchers from a broad swath of inter-related disciplines to offer the most up-to-date information about clinical and preclinical research into ketamine and second-generation “ketamine-like” fast-acting antidepressants. Currently available antidepressant medications act through monoaminergic systems, are ineffective for many individuals suffering from depression, and are associated with a delayed onset of peak efficacy of several months. The unexpected emergence of ketamine, an anesthetic N-methyl-D-aspartate (NMDA) receptor antagonist, as a rapid-acting antidepressant has reinvigorated CNS drug discovery research and catalyzed investigation in patient populations historically ignored in antidepressant drug development programs, particularly treatment-resistant patients and those with suicidality. Recent industry and academic research efforts have coalesced to explore NMDA receptor and glutamatergic molecular targets that lack ketamine’s psychotomimetic side effects and abuse liability but retain its rapid onset of efficacy. However, many fundamental questions remain regarding the neurobiological mechanisms underlying ketamine’s rapid antidepressant effects and the puzzling persistence of benefits observed in some patients following a single dose. This book examines how insights from these studies are forging new conceptual models of the neurobiology of stress-related affective, anxiety, and addictive disorders and the nature of treatment resistance. It also discusses how ketamine’s rapid antidepressant effects provide a scientific platform to facilitate innovation in clinical trial designs pertaining to patient selection, choice of control group, outcome measures, and dose-optimization. This book brings together data and insights from this rapidly expanding and extraordinarily promising field of study. Readers will be able to extract integrated themes and useful insights from the material contained in these diverse chapters and appreciate the paradigm-shifting contributions of ketamine to modern psychiatry and clinical neuroscience research.
An ideal health care system relies on efficiently generating timely, accurate evidence to deliver on its promise of diminishing the divide between clinical practice and research. There are growing indications, however, that the current health care system and the clinical research that guides medical decisions in the United States falls far short of this vision. The process of generating medical evidence through clinical trials in the United States is expensive and lengthy, includes a number of regulatory hurdles, and is based on a limited infrastructure. The link between clinical research and medical progress is also frequently misunderstood or unsupported by both patients and providers. The focus of clinical research changes as diseases emerge and new treatments create cures for old conditions. As diseases evolve, the ultimate goal remains to speed new and improved medical treatments to patients throughout the world. To keep pace with rapidly changing health care demands, clinical research resources need to be organized and on hand to address the numerous health care questions that continually emerge. Improving the overall capacity of the clinical research enterprise will depend on ensuring that there is an adequate infrastructure in place to support the investigators who conduct research, the patients with real diseases who volunteer to participate in experimental research, and the institutions that organize and carry out the trials. To address these issues and better understand the current state of clinical research in the United States, the Institute of Medicine's (IOM) Forum on Drug Discovery, Development, and Translation held a 2-day workshop entitled Transforming Clinical Research in the United States. The workshop, summarized in this volume, laid the foundation for a broader initiative of the Forum addressing different aspects of clinical research. Future Forum plans include further examining regulatory, administrative, and structural barriers to the effective conduct of clinical research; developing a vision for a stable, continuously funded clinical research infrastructure in the United States; and considering strategies and collaborative activities to facilitate more robust public engagement in the clinical research enterprise.
Writing with clarity, coherence, and optimism, the authors summarize fundamental principles, enumerate essential skills, and review recent empirical findings in the overlapping areas of clinical ethics and psychiatry. Case illustrations, tables, and strategic lists enhance the book's 17 informative chapters.
The aim of the American Psychiatric Association Practice Guideline series is to improve patient care. Guidelines provide a comprehensive synthesis of all available information relevant to the clinical topic. Practice guidelines can be vehicles for educating psychiatrists, other medical and mental health professionals, and the general public about appropriate and inappropriate treatments. The series also will identify those areas in which critical information is lacking and in which research could be expected to improve clinical decisions. The Practice Guidelines are also designed to help those charged with overseeing the utilization and reimbursement of psychiatric services to develop more scientifically based and clinically sensitive criteria.
Evolutionary psychology has recently made inroads in clinical psychology, bringing the understanding that, in some cases, mental symptoms are not manifestations of brain disorders, but rather evolved mechanisms that might function in overdrive or signal fitness problems. Thus, improvements in fitness may lead to improvements in those symptoms. Armed with such insights, this brief describes a comprehensive therapy protocol for depression – Cognitive Evolutionary Therapy (CET) –, which incorporates evolutionary understandings of this condition into well-validated cognitive techniques. CET starts with an evaluation of the evolutionary fitness of an individual, which represents the springboard for specific, evolutionary-driven behavioral and cognitive interventions. Based on the fitness evaluation, which takes place at intake, the CET therapist comes pre-equipped with a list of the patient’s fitness problems and can start working on them very early on in therapy, potentially leading to shorter interventions and cost savings. This brief will appeal to clinical psychologists and therapists who frequently employ CBT principles in therapy, as well as to clinicians who want to incorporate insights from evolutionary disciplines into their approaches.
The Cambridge Handbook of Applied Psychological Ethics is a valuable resource for psychologists and graduate students hoping to further develop their ethical decision making beyond more introductory ethics texts. The book offers real-world ethical vignettes and considerations. Chapters cover a wide range of practice settings, populations, and topics, and are written by scholars in these settings. Chapters focus on the application of ethics to the ethical dilemmas in which mental health and other psychology professionals sometimes find themselves. Each chapter introduces a setting and gives readers a brief understanding of some of the potential ethical issues at hand, before delving deeper into the multiple ethical issues that must be addressed and the ethical principles and standards involved. No other book on the market captures the breadth of ethical issues found in daily practice and focuses entirely on applied ethics in psychology.
Hope has long been a topic of interest for psychologists, philosophers, educators, and physicians. In the past few decades, researchers from various disciplines and from around the world have studied how hope relates to superior academic performance, improved outcomes in the workplace, and improved psychological and physical health in individuals of all ages. Edited by Matthew W. Gallagher and the late Shane J. Lopez, The Oxford Handbook of Hope provides readers with a thorough and comprehensive update on the past 25 years of hope research while simultaneously providing an outline of what leading hope researchers believe the future of this line of research to be. In this extraordinary volume, Gallagher, Lopez, and their expert team of contributors discuss such topics as how best to define hope, how hope is distinguished from related philosophical and psychological constructs, what the current best practices are for measuring and quantifying hope, interventions and strategies for promoting hope across a variety of settings, the impact it has on physical and mental health, and the ways in which hope promotes positive functioning. Throughout its pages, these experts review what is currently known about hope and identify the topics and questions that will help guide the next decade of research ahead.