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Oldham, John, MD

Journal of Psychiatric Practice®: September 2012 - Volume 18 - Issue 5 - p 317
doi: 10.1097/01.pra.0000419812.52881.1b


September, 2012. When I am giving talks or teaching about personality disorders, the content of the materi- al usually includes common patterns of Axis I/Axis II comorbidity. One question I frequently put to the audi- ence or the class goes something like this: When you are evaluating a new patient and you establish that the patient has severe and persistent schizophrenia on Axis I, does it even make sense to try and evaluate whether or not a personality disorder might also be present? Usually, the answer is no, and I generally agree, especially in cases in which the patient has been actively psychotic in a prolonged way and not very responsive to antipsychotic medications. But then I always add a postscript, pointing out that even in such patients, a case can be made at least to think about personality, since there is a person there “behind” the illness, and that per- son was there before the illness emerged. We try more and more to use “person-centered” language, and when I’m editing manuscripts for the Journal and find language such as “in this study, 56 schizophrenics and 60 con- trols were enrolled,” I’ll always change the wording to say “56 patients with schizophrenia….” Just the other day, a colleague was recalling some older papers in the literature referring to “the difficult patient” or “the hateful patient,” terms used in landmark papers that still have a lot to teach us. But today, we would use dif- ferent terms, such as “the patient with difficult-to-treat illness” or “the patient with treatment-refractory depression.” Even these terms are not ideal, but we have to keep looking for better ways to put the person back in our language and not to equate the person with the illness.

In this issue of the Journal, Seeman and Seeman call our attention to an important aspect that is often neg- lected in the treatment of patients with schizophrenia—the meaning to the patient of the medications being prescribed. Using clinical examples, the authors illustrate the many (sometimes overt but perhaps overlooked, and sometimes subtle) meanings that antipsychotic medications have for patients with schizophrenia, and the importance of sensitivity to and direct exploration of this dimension of treatment.

Also in this issue, Kuhnigk and colleagues present the results of a survey of the opinions of patients, fam- ilies, treating physicians, and treatment-authorizing payers about the treatment being provided to a group of patients with schizophrenia, revealing different priorities among the groups being surveyed. Nejtek and col- leagues, in another study reported in this issue, emphasize quality of life, depression, gender, and race as crit- ical variables to consider in the treatment of outpatients with psychotic disorders. Practical prescribing guidance regarding the atypical antipsychotics is provided in the column by Preskorn, which could be incor- porated into treatment discussions between patients and physicians—to include thinking about what is help- ing, what is not, and what the entire treatment experience means to the patient.

Editor’s Note: It is my pleasure to announce that, with this issue of the Journal, Marcia Verduin, MD, assumes the role of Book Editor. Marcy has served as Associate Book Editor since 2007, collaborating with the Journal’s first Book Editor, Carolyn Robinowitz, MD. I would personally like to thank Carolyn for her outstanding work in this capacity since 2003, and I’m delighted that she will remain an active member of the Journal’s Editorial Board. I am also pleased to announce that, starting in an upcoming issue, a new periodic column on Advocacy will appear, written by Anand Pandya, MD, who will join the Editorial Board in this capacity.

John Oldham, MD


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