The Physician as Patient: A Clinical Handbook for Mental Health Professionals

This article reports the results of the Survey of Law Student Well-Being (SLSWB) implemented in spring 2014 at fifteen law schools around the country. The SLSWB is the first multischool study in over twenty years to address law student use of alcohol and street drugs, and the first-ever multischool study to explore prescription drug use and the mental health concerns and help-seeking attitudes of law students. The results of the study indicate that roughly one-quarter to one-third of respondents reported frequent binge drinking or misuse of drugs, and/or reported mental health challenges. Moreover, the results indicated that significant majorities of those law students most in need of help are reluctant to seek it. The article concludes by discussing how law school administrators and other relevant leaders within the legal academy and legal profession can promote and improve wellness so that law students are better-positioned to find success as law students and to serve their future clients well as lawyers.

https://papers.ssrn.com/sol3/Delivery.cfm?abstractid=2839290

Suffering in Silence: The Survey of Law Student Well-Being and the Reluctance of Law Students to Seek Help for Substance Use and Mental Health Concerns

Barriers to seeking help for physicians with substance use disorder: A review.

Purpose/background In addition to clozapine, other atypical antipsychotic drugs pharmacologically similar to clozapine, for example, olanzapine, risperidone, and melperone, are also effective in a similar proportion of treatment-resistant schizophrenia (TRS) patients, ~40%. The major goal of this study was to compare 2 doses of lurasidone, another atypical antipsychotic drug, and time to improvement in psychopathology and cognition during a 6-month trial in TRS patients. Methods/procedures The diagnosis of TRS was based on clinical history and lack of improvement in psychopathology during a 6-week open trial of lurasidone 80 mg/d (phase 1). This was followed by a randomized, double-blind, 24-week trial of lurasidone, comparing 80- and 240-mg/d doses (phase 2). Findings/results Significant non-dose-related improvement in the Positive and Negative Syndrome Scale-Total and subscales and in 2 of 7 cognitive domains, speed of processing and executive function, were noted. Twenty-eight (41.8%) of 67 patients in the combined sample improved ≥20% in the Positive and Negative Syndrome Scale-Total. Of the 28 responders, 19 (67.9%) first reached ≥20% improvement between weeks 6 and 24 during phase 2, including some who had previously failed to respond to clozapine. Implications/conclusions Improvement with lurasidone is comparable with those previously reported for clozapine, melperone, olanzapine, and risperidone in TRS patients. In addition, this study demonstrated that 80 mg/d lurasidone, an effective and tolerable dose for non-TRS patients, was also effective in TRS patients but required longer duration of treatment. Direct comparison of lurasidone with clozapine in TRS patients is indicated.

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Lurasidone Improves Psychopathology and Cognition in Treatment-Resistant Schizophrenia.

Objective: This paper will define and describe impairment in medical practitioners due to mental illness, with special reference to the specialty of psychiatry, and then review the prevalence and identification of impaired practitioners. Methods: The quantitative and qualitative evidence regarding the incidence and impact of medical practitioner impairment due to mental illness (and, to some extent, substance use), with special reference to impaired psychiatrists, is reviewed. Results: Medical practitioner impairment due to mental illness has a severe impact on their lives and their families due to both the effects of the disorder and the experience of communal, professional and self stigma. Conclusions: The consequences of impairment among medical practitioners and specialist psychiatrists as well as the under-reporting of impaired practitioners is a significant problem.

Psychiatrically impaired medical practicioners: an overview with special reference to imparied psychiatrists

Burnout is Not Associated With Increased Medical Errors

Physician health program websites in 23 states provide many descriptions of possible physician impairment. This study sought to determine whether these descriptions are so broad that almost everyone might potentially be suspected of being impaired given these descriptions. The authors randomly selected 25 descriptions of impairment and then presented them anonymously online to members of the general population in full-time employment through Amazon’s Mechanical Turk (N = 199). Half of the respondents randomly received a narrowly worded version, and half received a broadly worded version of the survey questions. In the narrowly worded version of the survey, 70.9% of respondents endorsed at least one description of impairment, and 59.2% endorsed more than one. In the broadly phrased version, 96.9% endorsed at least one description, and 95.8% endorsed more than one. These respondents endorsed a median of 10 out of 25 (40%) descriptions. These findings call into question whether these descriptions really identify persons with poor performance or who pose a high risk of substantial, imminent harm to self or others in the workplace. They also demonstrate the extent to which these descriptions could potentially be misapplied and brand almost anyone as impaired.

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How broad are state physician health program descriptions of physician impairment

Do state physician health programs encourage referrals that violate the Americans with Disabilities Act

Flaws in the methods and reporting of physician health program outcome studies.

J enny is a postgraduate year 2 resident in psychiatry with satisfactory rotation evaluations in the middle range of her class, with no incidents. One day, she is asked why she decided to become a physician. She states that she had major depressive disorder as a teenager, and she decided to specialize in psychiatry to help teenagers with similar problems. Her response is relayed to hospital management. Can the hospital request that she undergo an administrative psychiatric evaluation? Program directors sometimes request that a resident undergo an administrative psychiatric evaluation to ensure patient safety. Still, what are the laws that apply to these requests? The Americans with Disabilities Act (ADA) prohibits an employer from requesting psychiatric information from, or requiring a psychiatric evaluation of, an employee unless there is a reasonable belief based on objective evidence that

/pdf/the-administrative-psychiatric-evaluation-4qm1b7mqz0.pdf

Nicholas D. Lawson

Papers

Burnout is Not Associated With Increased Medical Errors

How broad are state physician health program descriptions of physician impairment

Do state physician health programs encourage referrals that violate the Americans with Disabilities Act

Flaws in the methods and reporting of physician health program outcome studies.

The Administrative Psychiatric Evaluation