I thought I would ask basically to see if I can be more helpful. My interest in writing this blog came about because I had many people ask me what I was reading. They seemed to find my information sources to be interesting. A secondary interest of mine is making sure that the best possible information is available to clinicians who are on the front lines making decisions each day. Thirdly, the analysis of research whether it is basic science or clinical research is also an interest - both the scientific measures but also the rhetorical aspects. Many people don't think that rhetoric enters into medicine and science. If you are a psychiatrist we have been contending with rhetoric for decades whether we want to or not and it has extended into literature that most would consider to be scientific. There are a lot of posts about that rhetoric on this blog. Fourth - I post about society, culture, and politics and how that impacts us. I have frequent posts on the cultural effects on behavior - with many posts on my hypotheses about how gun extremism affects us all and is associated with the American mass shooter phenomenon. Fifth - I have posts on diagnostic reasoning and taught a course to medical students about this for a decade in the past. I try to tie in diagnostic thinking in psychiatry as a comparison. Sixth - I have done book reviews on poetry with psychiatric themes and consciousness and am currently reviewing another poetry book, Keith Rasmussen's book on ketamine, and a book on spirituality where I hope to illustrate a path to connecting that to psychiatry.
My most viewed page recently has been the updated review of systems for psychiatrists. This is actually a tool I use in clinical practice and there are several other pages like it. It has recently been viewed over 31,000 times - but I think at some point Blogger (the Google interface that this is published in) - stopped counting page views from virtual private networks (VPNs) by the page and only counts them in aggregate - where there are about 2.1 million views. Additional highly viewed pages about clinical psychiatry include 2000 Words About the Last Ten Minutes of a Psychiatric Evaluation and Additional Work on the Review of Systems for Psychiatrists.
Posts that are currently pending include:
1: Updated post on Neanderthals and why they disappeared. Paleogenetics is a fascinating read and it has implications for human illnesses, evolutionary aspects of psychiatry, and the evolution of man.
2: Review of the poetry book Coming to Love My Darkest Places by Jennifer Kelly.
3: Review of The Varieties of Spiritual Experience by David B. Yaden and Andrew B. Newberg.
4: Review of Ketamine: The Story of Modern Psychiatry's Most Fascinating Molecule by Keith Rasmussen.
5: Continued posts on the rhetoric of medicine and psychiatry including the theory of that rhetoric.
6: Continued posts on the importance of biological theory to psychiatry. I am referring to theory that originates in biology rather than the usual biological hypotheses in psychiatry although they are not mutually exclusive. I hope that I give the impression that I am not very impressed with the proliferation of purely philosophical ideas about the field, especially from people who have never been trained in psychiatry or medicine.
7: A musculoskeletal case including images (CT, MRI, bone) with a discussion of complex misdiagnosis and how all of that applies to psychiatry.
I will avoid a top ten list of what is coming, but that is what is percolating right now. I tend to work better when I am thinking (and writing) about many things at once. My motivation for this brief post is too see if there are any topics that readers would either like to see or like to see elaborated on. They can be clinical or theoretical - medical or psychiatric. Feel free to send me your ideas either posted here or to my direct email address.
I would also like to address two related topics. The first is the use of these blog posts. I think most people read them for their own interest, but some have been incorporated into books. Everything on this blog is Creative Commons licensed. That means it can be shared for no charge in just about any medium that you want it to be. The only stipulation is that you cite me and this blog as a source. I have found myself in the awkward situation of being at a conference and seeing my blog pages projected by a prominent researcher without referencing my work. I do not make any money writing this blog. I have no paid subscribers or advertisers and pay all of the expenses out of my own pocket. I think one line of 12 point font referencing my work in the bottom corner of a PowerPoint slide is not too much to ask.
Even better, I am happy to collaborate. I am willing to research, cowrite, or make graphics for your project for co-authorship credit and nothing else. In fact, I recently offered to analyze the utilization of psychiatric medications for a large healthcare plan for free. They declined the offered but I remain very interested in the analysis of real world data in health care setting. Send me an email if you are interested.
George Dawson, MD, DFAPA
Supplementary 1:
Requests for topics:
1: ADHD – rates of
diagnosis, how people present for assessment, missed diagnoses and other
associated problems, diagnosing adults, and neurodevelopmental diagnoses in
general. (see comment below).
2: ADHD – stimulant treatment
and cannabis use.
3: Antidepressant
withdrawal with a focus on gastrointestinal symptoms.
4: The models of
mental functioning that are helpful in psychiatry.
5: Indications/guidelines
for antipsychotic use in children and teenagers. Data on long term use.
6: Memory and
cognitive problems associated with POTS (Postural orthostatic tachycardia
syndrome) – and recommended medical treatment.
7: How psychiatry was
practiced and the current transition – implications for the future of the field.
8: Dementias associated
with Lyme Disease and other infectious diseases
9: More biological
psychiatry!
10: Pharmacology and psychiatric applications of alpha-1 and
alpha-2 adrenergic receptor agonists and antagonists.
11: Pharmacology and
psychiatric applications of beta adrenergic antagonists in psychiatry.
12: What are inverse
agonists in 10 and 11 above?
13: Post Finasteride
Syndrome (PFS) – I continue to get treatment requests for this syndrome. Some of the people sending me emails explain
that I am listed on web sites as a treatment resource, even though I have never
personally assessed or treated the disorder.
I will probably post a review on PFS in the next year.
14: Post SSRI Sexual Dysfunction
(PSSD)/Persistent Genital Arousal Disorder (PGAD) – I have posted a review of
this disorder and I am listed on web sites as a treatment resource. I have also
had at least one person try to convince me to remove my post or modify it to
their liking.
https://real-psychiatry.blogspot.com/2023/07/post-ssri-sexual-dysfunction-pssd.html
15: Antidepressant
withdrawal/discontinuation: I have
posted on this and my opinions are all consistent with a recent major review. I am always interested in medication side
effects – no matter the medication and how they can be mitigated. I have also
had treatment requests to assist with this problem. I will probably add a post
on the major review and also continue to comment on the politicization and the
associated rhetoric. As well as placebo/nocebo responses.
https://real-psychiatry.blogspot.com/2018/06/the-problem-of-antidepressant.html
16: Supportive
psychotherapy: Throughout my career I
practiced supportive psychotherapy in practically every clinical encounter and
across every diagnostic category. I
consider it to be a necessary skill for psychiatrists – but it is difficult to
write about in terms of both observations and techniques. At some point I will be posting about this.
17: How to walk down stairs and minimize the risk of falling: That's right - I am a psychiatrist and old speedskater with an interest in biomechanics. I will post this as soon as I can figure out how to draw stick figures walking up and down stairs. Let me know if there is software out there that might help with this type of drawing.
That should keep me going for a while. Do not hesitate to send more ideas or
questions.
A final note on treatment requests. I have received these requests as noted on
#13, #14, and #15 above from many different states. My response is always that I am retired from
clinical practice and no longer provide active treatment since 1/19/2021. That also means that I do not have access to
what is required to provide medical care and meet licensing requirements
(records, malpractice insurance, support staff, etc.). And even if I did – treating people across
state lines remains somewhat of a logistic nightmare. As a result, I cannot provide telepsychiatry
services or casual advice. What I write
on the blog has always been educational and for a large part directed at
physicians and more specifically psychiatrists.
It is not medical advice and I hope I have always emphasized that the
best treatment with continuity is available from your local physicians and
specialists. Proper medical care requires a formal doctor-patient relationship and that cannot be casual advice. And for the physicians out
there I hope I come across as an interested colleague. Another intent in writing this blog is not to
suggest that my knowledge or practice is superior to anyone else. Life, biology, and medicine are too
complicated for that.
Supplementary 2:
Elements of a dynamic textbook: In my spare time I will be arranging my blog posts from the past 12 years in the general form of a book. The intention is not to create a book but an outline for a book. Not all of the posts will translate well but most will. I would like it to be dynamic - not psychodynamic but useful to all psychiatrists. Typical texts waste too much space on just technical details and I would prefer to focus on key concepts and approaches including how that evolves. I will post the outline here when I have it - in the meantime feel free to suggest chapters.
