“Be careful, doctor. Don’t order lab tests that you don’t really need. You’re asking for trouble.” No, that’s not TCR talking. That’s none other than George Lundberg, M.D., former editor of JAMA. He made that statement in an editorial webcast in January 2005 on Medscape, where Dr. Lundberg is Editor-in-Chief.

Dr. Goldberg, I know you’ve spent a lot of time thinking about and treating bipolar disorder over the years, beginning when you were a researcher at NIMH, then on the faculty of Columbia University, and most recently in your private practice and your managing of Depression Central. I was hoping we could begin by discussing some of the tricky aspects of diagnosing bipolar disorder.

There have been many misguided treatments for bipolar disorder and other major mental illnesses throughout the history of psychiatry, but perhaps none has been as misguided--and as damaging--as the one practiced by Henry Aloysius Cotton, M.D.

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Many pages of The Carlat Report have been devoted to how we cause our patients to become obese with some of the medications we prescribe. In this article, we review ways in which we can atone for our sins.

Too many of our patients smoke, especially those with schizophrenia. Amazingly, the best estimate is that 85% of patients with schizophrenia are regular smokers (Am J Psychiatry 1986; 143:993-997). While we may not have a whole lot of time during our sessions to discuss smoking, it’s still helpful to tuck away some smoking cessation tools in your arsenal.

Dr. Guttmacher, as the Chief of Psychiatry at a large state hospital (the Rochester Psychiatric Center), you have a wealth of experience caring for the chronically mentally ill. I know you have been giving quite a bit of thought lately to medical issues that psychiatrists may be missing in this population.

Archeological evidence suggests that tobacco grew in the Americas as long ago as 6000 B.C., and that the custom of smoking it began with the Mayans, sometime around 1000 B.C. The first European to smoke is thought to be Rodrigo de Jerez, who, with Christopher Columbus, observed the custom in Cuba in 1493.

Okay, we’re assuming, number one, that you have done a good job diagnosing ADD or ADHD, and that ADHD is the primary diagnosis, far out-shadowing any comorbid problems that may also be present. And number two, we are assuming that you, the patient, and the parents (if the patient is under age) have all agreed that now is the time for a medication trial.