Faculty Bibliography

Pharmacogenomic testing in clinical psychiatry has grown at an accelerated pace in the last few years and is poised to grow even further. Despite robust evidence lacking regarding efficacy in clinical use, there continues to be growing interest to use it to make treatment decisions. We intend this article to be a primer for a clinician wishing to understand the biological bases, evidence for benefits, and pitfalls in clinical decision-making. Using clinical vignettes, we elucidate these headings in addition to providing a perspective on current relevance, what can be communicated to patients, and future research directions. Overall, the evidence for pharmacogenomic testing in psychiatry demonstrates strong analytical validity, modest clinical validity, and virtually no evidence to support clinical use. There is definitely a need for more double-blinded randomized controlled trials to assess the use of pharmacogenomic testing in clinical decision-making and care, and until this is done, they could perhaps have an adjunct role in clinical decision-making but minimal use in leading the initial treatment plan.

Reviews the book, Evidence-Based Practice in Suicidology: A Source Book edited by Maurizio Pompili and Roberto Tatarelli (see record 2010-19229-000). This volume commences with a series of papers describing research methods and their limitations at arriving at conclusions that may be generalized to larger populations. The contributors discuss ethical and methodological problems inherent in suicide research as well as the limitations of the best evidence we have to define a population at risk. Considerable discussion is given to the relative efficacy of interventions that have proven useful and strategies for risk reduction, including programs of public awareness, restriction of lethal means, and impact of media reporting of suicide. Change in risk over the life cycle is addressed with specific chapters on youth and late-life suicide. Evidence of efficacy of cognitive-behavioral therapy, dialectical behavior therapy, and problem-solving training in management of suicidal patients is provided. Specific evidence-based psychopharmacologic interventions are enumerated in the context of biological understanding of self-directed violence. In conclusion, evidence-based guidelines for evaluation of risk for self-inflicted death and institutional, professional, and community strategies for risk reduction are provided. The level of evidence may not be on a par with some medical interventions-such as to reduce risk of lung or colonic cancer-but the decision to die by one's own hand is not a simple molecular issue. Suicide results from a complex interplay of psychological, biogenetic, sociocultural, and existential variables. This book summarizes what we know and what we need to explore to know better how to help our patients and their families. It should be read by heath professionals, educators, and community leaders working with populations at risk to reduce the tragedy of life lost by suicide.

Emergency psychiatry was once deemed a necessary component of psychiatric care but not a preferred specialty interest. The practice of psychotherapy with or without psychopharmacotherapy was the usual career choice. Today with decreasing hospital stays, rising acuity of patients presenting for crisis care and the increasing comorbidity occurring with a particular disorder demands that all primary care providers and mental health professionals have some emergency psychiatric skill.

Considerable advances have been made since the mid-20th century in understanding and treating the suicidal patient. Self-inflicted death is the fourth leading cause of death in adults 18-65 years of age. Approximately 25,000-30,000 individuals kill themselves annually. The most outstanding advances in care of suicidal patients are due to both the better understanding of the neurochemistry of impulsive violence and to the development of psychopharmacotherapy and psychotherapies that target disorders associated with increased risk. (journal abstract)

The authors reviewed historical literature and hypothesized a relationship between epidemics of sexually transmitted diseases and foot fetishism. They tested this hypothesis by quantifying foot-fetish depictions in the mass-circulation pornographic literature during a 30-yr. interval. An exponential increase was noted during the period of the current AIDS epidemic. The authors offer reasons for this possible relationship