Top 10 Stories in Psychiatry of 2003: New Scientific Knowledge and Research, in Addition to Drug Approvals, Changed Landscape for Clinicians
Evans, Jeff, Clinical Psychiatry News
Last year saw new concerns for strengthening and expanding mental health services across the country as well as a host of new drug approvals that broaden the range of available prescribing choices for psychiatrists treating disorders with relatively large prevalences in the United States. Those in the specialty also gained an understanding of rarely noted problems in mental health that may occur in both patients and physicians, and expanded their insight into the complex genetics that play a role in psychiatric disorders.
Let us take you back to CLINICAL PSYCHIATRY NEWS' top 10 stories for 2003, in no specific order. In selected cases, members of the publication's editorial advisory board provided comment.
Additional Therapy for ADHD
The Food and Drug administration approved Eli Lilly & Co.'s atomoxetine (Strattera), the first new type of drug for ADHD to be approved in 3 decades, after analyzing the results of six double-blind trials. The nonstimulant nature of atomoxetine, a selective norepinephrine reuptake inhibitor, dodges a controlled substance classification, which will make it more convenient for physicians to distribute samples and to phone in prescriptions and refills to pharmacies.
The drug has yet to have its efficacy and safety adequately compared against stimulant drugs such as methylphenidate. But atomoxetine may be a good choice for adults with ADHD and comorbid conditions that contraindicate the use of stimulants, such as anxiety, mood, and tic disorders ("Nonstimulant Atomoxetine Approved for ADHD, January 2003, p. 5).
Physicians and Suicide
The best available data on physician suicide shows that male physicians have a relative risk of suicide that is up to three times as high as the general population. Female physicians have a risk of up to six times that of the general population ("Suicide Is Top Cause of Early Death Among MDs," February 2003, p. 1).
"I think it is one of the great tragedies that the medical profession does not understand or attend very well to the stresses of practice," said Dr. Paul J. Fink, who is a member of CLINICAL PSYCHIATRY NEWS' editorial advisory board. "I think it is time for us to make the [American Medical Association], the [American Association of Medical Colleges], the [Accreditation Council for Graduate Medical Education], and other organizations that have to do with the requirements and standards for medical students and residents begin to think about the humanism needed to practice medicine, and the fact that if you are not treated humanely in your training, you will take what you have learned while training into the practice of medicine and be one of the many millions of bad doctors who practice 'good' medicine."
Treating Social Anxiety
Sertraline (Zoloft) and the extended-release formulation of venlafaxine (Effexor) joined paroxetine (Paxil) as the only drugs approved by the Food and Drug Administration for social anxiety disorder. Two double-blind, placebo-controlled, multicenter trials of more than 600 adult patients formed the basis of sertraline's approval ("Two More Drugs Approved for Social Anxiety," March 2003, p. 6). Sertraline is a selective serotonin reuptake inhibitor marketed by Pfizer Inc.
Two 12-week trials of venlafaxine, a serotonin and norepinephrine reuptake inhibitor marketed by Wyeth, were analyzed by the FDA. The approval of the two drugs will help to "broaden our range of possibilities for effective treatment," said Dr. Michael Liebowitz, director of the anxiety disorders clinic at the New York State Psychiatric Institute in New York City.
In 2003, U.S. graduating seniors filled 649 positions in all psychiatry categories, which was 22 more than in 2002. The increase was not statistically significant when compared with the 16,000 U.S. medical students who graduated in 2003, but psychiatry resident programs have seen a 35% increase in the number of U. …