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IIn 1922 Alfred Hoche a German psychiatrist co-authored a document demanding the extermination of persons he believed were a burden to society. In 1933 Adolph Hitler followed up on this by introducing obligatory sterilization of people with diseases he believed to be inheritable including mental retardation, schizophrenia, affective psychosis, and alcoholism. In July 1939 a plan was developed with the assistance of leading psychiatrists for the extermination of this group of people. Torrey and Yolken in their analysis of the literature believe that the entire population of people with schizophrenia (between 220,000 and 295,000 people) living in Germany at the time were either sterilized or killed. After the invasion of Poland the systematic murders of patients in various psychiatric hospitals were carried out. There are reports of only two psychiatrists who chose to stay with their patients and both perished. This plan to eliminate schizophrenia did not succeed probably because it is not entirely a genetic disease. We should never forget those whose lives were taken during this time and how and why they they were killed.

At the present time if a U.S. soldier who served in Iraq or Afghanistan is physically and/or psychologically injured and subsequently commits suicide, his or her family will not receive a Presidential letter of condolence as will soldiers who die by other means. This is unfair and hurtful to the families with loved ones who have volunteered to serve their country and die as a result of their service. A spokesperson for President Obama said that the policy in regard to who should receive a letter of condolence is currently undergoing a review. This issue is discussed and it is suggested that letters be written to the President, Secretary of Defense and members of Congressas well as professional organizations such as the American Psychiatric Association which could influence these people, urging that the above policy be changed so Presidential letters of condolence will also be written to soldiers who have died from suicide.

After recently moving to California and experiencing a mild earthquake I decided to obtain an extra month supply of prescription medication for my family and myself as this is recommended for disaster preparedness. I found out that this is a very difficult thing to do and furthermore most insurance companies won’t pay for it. Experts working in disasters know that people frequently don’t have access to their everyday medications. While there may be some exceptions such as concern about addiction or suicidal tendencies, most people should have the ability to obtain an extra month supply of their medication above that which is usually prescribed for them. The author co-authored a resolution at the Assembly of the American Psychiatric Association that would have this organization work with other medical groups and interested parties to advocate that laws and regulations be changed to allow individuals to have extra medication on hand for emergencies and disasters. The readers of this blog were asked to check the situation where they live in the U.S. or internationally in regard to this problem and to report in the comment section of this blog.

This blog discusses how the understanding of the human genome and the construction of the human chromosome may be able to influence psychiatric care. Psychiatrists have previously relied on history ( including family history ) with a mental status evaluation to make a diagnosis and develop a treatment plan. Unless the patient had an identical twin with similar symptoms, family history only has a limited value in providing assistance in making the diagnosis or in predicting response to medication. The author originally hoped that this would radically change with the breaking of the genetic code and the human genome project. However thus far the research has limited value in the application to current psychiatric care. There is some promising research in regard to schizophrenia and genetics as well as some recent work concerning bipolar disorder and post partum depression, which is reviewed. The use of biomarkers particularly in brain imaging and the use of the EEG for the prediction of effectiveness for antidepressants are discussed. Several ethical considerations related to this type of research are also raised.

Tierra del Sol is a non profit organization serving people who are developmentally disabled. It has a small campus in Sunland, California where each day 250 adults are bussed in to participate is an individually designed curriculum. The programs include farm work, computer learning, art classes and kitchen training. People with developmental disabilities have a high prevalence of mental health problems, which can be difficult to diagnose. Mental health services for this group are more time consuming and therefore more expensive. As we are reevaluation our health care system in the U.S., this is the time to be sure that adequate mental health care for this is group is included in our health care program.


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