The American Journal of Psychiatry

The American Journal of Psychiatry is a monthly peer-reviewed medical journal covering all aspects of psychiatry, and is the official journal of the American Psychiatric Association.[1] The first volume was issued in 1844, at which time it was known as the American Journal of Insanity. The title changed to the current form with the July issue of 1921.

According to the Journal Citation Reports, the journal has a 2017 impact factor of 13.391.[1]

American Journal of Psychiatry
Edited byRobert Freedman
Publication details
Former name(s)
American Journal of Insanity
Publication history
Standard abbreviations
Am. J. Psychiatry
ISSN0002-953X (print)
1535-7228 (web)
OCLC no.1480183

Ethical concerns

Several complaints, including legal cases, have charged The American Journal of Psychiatry with being complicit in pharmaceutical industry corruption of clinical trial results.[2] In a Department of Justice case against Forest Pharmaceuticals, Forest pleaded guilty to the charges of misbranding the drug Celexa (citalopram).[3] The Complaint in Intervention clearly identifies a 2004 ghostwritten article published in ‘’The American Journal of Psychiatry in the names of Wagner et al[4] as a part of this illegal marketing of Celexa for pediatric depression.[5]

See also


  1. ^ a b "About The American Journal of Psychiatry". American Psychiatric Association. 2016. Retrieved 2016-05-07.
  2. ^ The citalopram CIT-MD-18 pediatric depression trial: Deconstruction of medical ghostwriting, data mischaracterisation and academic malfeasance' by Jureidini, Jon, Amsterdam, Jay, McHenry, Leemon, International Journal of Risk & Safety in Medicine. 2016 28[1]:33-43.
  3. ^ United States v Forest Pharmaceuticals, Plea Agreement, September 15, 2010
  4. ^ Wagner KD, Robb AS, Findling RL, Jin J, Gutierrez MM, Heydorn WE. A randomized, placebo-controlled trial of citalopram for the treatment of major depression in children and adolescents. Am J Psych 2004; 161 (6): 1079-1083.
  5. ^ United States v Forest Pharmaceuticals, Complaint in Intervention p. 17. section 60.

External links

50 Signs of Mental Illness

50 Signs of Mental Illness: A Guide to Understanding Mental Health is a 2005 book by psychiatrist James Whitney Hicks published by Yale University Press. The book is designed as an accessible psychiatric reference for non-professionals that describes symptoms, treatments and strategies for understanding mental health.The 50 signs covered in the book are: Anger, Antisocial Behavior, Anxiety, Appetite Disturbances, Avoidance, Body Image Problems, Compulsions, Confusion, Deceitfulness, Delusions, Denial, Depression, Dissociation, Euphoria, Fatigue, Fears, Flashbacks, Grandiosity, Grief, Hallucinations, Histrionics, Hyperactivity, Identity Confusion, Impulsiveness, Intoxication, Jealousy, Learning Difficulties, Mania, Memory Loss, Mood Swings, Movement Problems, Nonsense, Obsessions, Oddness, Panic, Paranoia, Physical Complaints and Pain, Psychosis, Religious Preoccupations, Self-Esteem Problems, Self-Mutilation, Sexual Performance Problems, Sexual Preoccupations, Sleep Problems, Sloppiness, Speech Difficulties, Stress, Suicidal Thoughts, and Trauma.A review in the American Journal of Psychiatry commended its phrasing of acceptable ways to speak about mental illness.

Activation-synthesis hypothesis

The activation-synthesis hypothesis, proposed by Harvard University psychiatrists John Allan Hobson and Robert McCarley, is a neurobiological theory of dreams first published in the American Journal of Psychiatry in December 1977. The differences in neuronal activity of the brainstem during waking and REM sleep were observed, and the hypothesis proposes that dreams result from brain activation during REM sleep. Since then, the hypothesis has undergone an evolution as technology and experimental equipment has become more precise. Currently, a three-dimensional model called AIM Model, described below, is used to determine the different states of the brain over the course of the day and night. The AIM Model introduces a new hypothesis that primary consciousness is an important building block on which secondary consciousness is constructed.


Alprazolam, sold as the trade name Xanax among others, is a short-acting benzodiazepine. It is most commonly used in short term management of anxiety disorders, specifically panic disorder or generalized anxiety disorder (GAD). Other uses include chemotherapy-induced nausea, together with other treatments. GAD improvement occurs generally within a week. Alprazolam is available by mouth.Common side effects include sleepiness, depression, headaches, feeling tired, dry mouth, and memory problems. Some of the sedation and tiredness may improve within a few days. Due to concerns about misuse, some do not recommend alprazolam as an initial treatment for panic disorder. Withdrawal or rebound symptoms may occur if use is suddenly decreased. Other rare risks include suicide, possibly due to loss of inhibition. Gradually decreasing the dose over weeks or months may be required. Alprazolam, like other benzodiazepines, binds to the GABAA receptor through which it acts.Alprazolam was approved for medical use in 1981. Overall in 2010 it was the 12th most prescribed medicine in the United States. Alprazolam is a Schedule IV controlled substance and is a common drug of abuse. It is available as a generic medication. The wholesale cost in the United States is less than 0.03 USD per dose as of 2018. In 2016 it was the 19th most prescribed medication in the United States with more than 27 million prescriptions.

Amariah Brigham

Amariah Brigham (December 26, 1798, in New Marlborough, Massachusetts – September 8, 1849, in Utica, New York) was an American psychiatrist and, in 1844, one of the founding members of the Association of Medical Superintendents of American Institutions for the Insane, which eventually became the American Psychiatric Association. While serving as the first director of the Utica Psychiatric Center, Dr. Brigham launched and became the first editor of the Association's official journal, The American Journal of Insanity (now called The American Journal of Psychiatry).

Bessel van der Kolk

Bessel van der Kolk (born 1943) is a Boston-based psychiatrist noted for his research in the area of post-traumatic stress since the 1970s. His work focuses on the interaction of attachment, neurobiology, and developmental aspects of trauma’s effects on people.

Bessel van der Kolk MD, professor of Psychiatry at Boston University School of Medicine and President of the Trauma Research Foundation in Brookline Massachusetts, has spent his career studying how children and adults adapt to traumatic experiences, and translated emerging findings from pharmacology, neuroscience and attachment research to develop and study potentially effective treatments for traumatic stress in children and adults. In 1984 he set up one of the first clinical/research centers in the US dedicated to study and treatment of traumatic stress in civilian populations, which has trained numerous researchers and clinicians specializing in the study and treatment of traumatic stress, and which has been continually funded to research the impact of traumatic stress and effective treatment interventions.

He conducted the first studies on the effects of SSRIs on PTSD; was a member of the first neuroimaging team to investigate how trauma changes brain processes, and did the first research linking BPD and deliberate self-injury to trauma and neglect in early childhood. Much of his research has focused on how trauma has a different impact at different stages of development, and that disruptions in care-giving systems have additional deleterious effects that need to be addressed for effective intervention.

In order to promote a deeper understanding of the impact of childhood trauma and to foster the development and execution of effective treatment interventions he initiated the process that led to the establishment of the National Child Traumatic Stress Network (NCTSN), a Congressionally mandated initiative that now funds approximately 150 centers specializing in developing effective treatment interventions, and implementing them in a wide array of settings, from juvenile detention centers to tribal agencies, nationwide. Based on data on 20,000 children followed within the Network he and his colleagues proposed to include a diagnosis Developmental Trauma Disorder within the DSM5. While that effort failed, they have continue to systematically study the differential adaptation to trauma in children, in the expectation that this will eventually lead to a more precise diagnostic system that incorporates the effects of early experience on RDoC-related neurocircuits, and provide more precise targets for intervention.

Following in the footsteps of Abram Kardiner who called traumatic stress a “physioneurosis” he has focused on studying treatments that stabilize physiology, increase executive functioning and help traumatized individuals to feel fully alert to the present. This has included an NIMH funded study on EMDR and NCCAM funded study of yoga, and, in recent years, the study of neurofeedback to investigate whether attentional and perceptual systems (and the neural tracks responsible for them) can be altered by changing EEG patterns, as well as MDMA and other mind altering substances to change PTSD symptomatology. He has an well-trained clinical team that specializes in the treatment of children and adults with histories of child maltreatment, a research lab that studies the effects of neurofeedback on behavior, mood, and executive functioning, as well as a MAPS funded laboratory that studies the effects of MDMA on PTSD. He teaches nationally and internationally to a variety of mental health professional, educators, parent groups, policy makers, and law enforcement personnel.

Van der Kolk was born in the Netherlands.

Borderline personality disorder

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a long-term pattern of abnormal behavior characterized by unstable relationships with other people, unstable sense of self and unstable emotions. There is often dangerous behavior and self-harm. People may also struggle with a feeling of emptiness and a fear of abandonment. Symptoms may be brought on by seemingly normal events. The behavior typically begins by early adulthood and occurs across a variety of situations. Substance abuse, depression, and eating disorders are commonly associated with BPD. Up to 10% of people affected die by suicide.BPD's causes are unclear but seem to involve genetic, brain, environmental and social factors. It occurs about five times more often in a person who has an affected close relative. Adverse life events also appear to play a role. The underlying mechanism appears to involve the frontolimbic network of neurons. BPD is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a personality disorder, along with nine other such disorders. Diagnosis is based on the symptoms, while a medical examination may be done to rule out other problems. The condition must be differentiated from an identity problem or substance use disorders, among other possibilities.Borderline personality disorder is typically treated with therapy, such as cognitive behavioral therapy (CBT). Another type, dialectical behavior therapy (DBT), may reduce the risk of suicide. Therapy may occur one-on-one, or in a group. While medications do not cure BPD, they may be used to help with the associated symptoms. Some people require care in hospital.About 1.6% of people have BPD in a given year. Females are diagnosed about three times as often as males. It appears to become less common among older people. Up to half of people improve over a ten-year period. People affected typically use a high amount of healthcare resources. There is an ongoing debate about the naming of the disorder, especially the suitability of the word borderline. The disorder is often stigmatized in both the media and the psychiatric field.

Bulimia nervosa

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives. Other efforts to lose weight may include the use of diuretics, stimulants, water fasting, or excessive exercise. Most people with bulimia are at a normal weight. The forcing of vomiting may result in thickened skin on the knuckles and breakdown of the teeth. Bulimia is frequently associated with other mental disorders such as depression, anxiety, and problems with drugs or alcohol. There is also a higher risk of suicide and self-harm.Bulimia is more common among those who have a close relative with the condition. The percentage risk that is estimated to be due to genetics is between 30% and 80%. Other risk factors for the disease include psychological stress, cultural pressure to attain a certain body type, poor self-esteem, and obesity. Living in a culture that promotes dieting and having parents that worry about weight are also risks. Diagnosis is based on a person's medical history; however, this is difficult, as people are usually secretive about their binge eating and purging habits. Further, the diagnosis of anorexia nervosa takes precedence over that of bulimia. Other similar disorders include binge eating disorder, Kleine-Levin syndrome, and borderline personality disorder.Cognitive behavioral therapy is the primary treatment for bulimia. Antidepressants of the selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant classes may have a modest benefit. While outcomes with bulimia are typically better than in those with anorexia, the risk of death among those affected is higher than that of the general population. At 10 years after receiving treatment about 50% of people are fully recovered.Globally, bulimia was estimated to affect 3.6 million people in 2015. About 1% of young women have bulimia at a given point in time and about 2% to 3% of women have the condition at some point in their lives. The condition is less common in the developing world. Bulimia is about nine times more likely to occur in women than men. Among women, rates are highest in young adults. Bulimia was named and first described by the British psychiatrist Gerald Russell in 1979.

Eating disorder

An eating disorder is a mental disorder defined by abnormal eating habits that negatively affect a person's physical or mental health. They include binge eating disorder where people eat a large amount in a short period of time, anorexia nervosa where people eat very little and thus have a low body weight, bulimia nervosa where people eat a lot and then try to rid themselves of the food, pica where people eat non-food items, rumination disorder where people regurgitate food, avoidant/restrictive food intake disorder where people have a lack of interest in food, and a group of other specified feeding or eating disorders. Anxiety disorders, depression, and substance abuse are common among people with eating disorders. These disorders do not include obesity.The causes of eating disorders are not clear. Both biological and environmental factors appear to play a role. Cultural idealization of thinness is believed to contribute. Eating disorders affect about 12 per cent of dancers. Individuals who have experienced sexual abuse are also more likely to develop eating disorders. Some disorders such as pica and rumination disorder occur more often in people with intellectual disabilities. Only one eating disorder can be diagnosed at a given time.Treatment can be effective for many eating disorders. Typically, this involves counselling, a proper diet, a normal amount of exercise, and the reduction of efforts to eliminate food. Hospitalization may be needed in more serious cases. Medications may be used to help with some of the associated symptoms. About 70% of people with anorexia and 50% of people with bulimia recover within five years. Recovery from binge eating disorder is less clear and estimated at 20% to 60%. Both anorexia and bulimia increase the risk of death.In the developed world binge eating disorder affects about 1.6% of women and 0.8% of men in a given year. Anorexia affects about 0.4% and bulimia affects about 1.3% of young women in a given year. Up to 4% of women have anorexia, 2% have bulimia, and 2% have binge eating disorder at some point in time. Anorexia and bulimia occur nearly ten times more often in females than males. Typically, they begin in late childhood or early adulthood. Rates of other eating disorders are not clear. Rates of eating disorders appear to be lower in less developed countries.

Grandiose delusions

Grandiose delusions (GD), delusions of grandeur, expansive delusions are a subtype of delusion that occur in patients suffering from a wide range of psychiatric diseases, including two-thirds of patients in manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, and a substantial portion of those with substance abuse disorders. GDs are characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. About 10% of healthy people experience grandiose thoughts but do not meet full criteria for a diagnosis of GD. .

List of presidents of the American Psychiatric Association

Presidents of the American Psychiatric Association

Macdonald triad

The Macdonald triad (also known as the triad of sociopathy or the homicidal triad) is a set of three factors that has been suggested (Macdonald 1963), if all three or any combination of two, are present together, to be predictive of or associated with later violent tendencies, particularly with relation to serial offenses. The triad was first proposed by psychiatrist J.M. Macdonald in "The Threat to Kill", a 1963 paper in the American Journal of Psychiatry. Small-scale studies conducted by psychiatrists Daniel Hellman and Nathan Blackman, and then FBI agents John E. Douglas and Robert K. Ressler along with Dr. Ann Burgess, claimed substantial evidence for the association of these childhood patterns with later predatory behavior. Although it remains an influential and widely taught theory, subsequent research has generally not validated this line of thinking.The triad links cruelty to animals, obsession with fire-setting, and persistent bedwetting past a certain age, to violent behaviors, particularly homicidal behavior and sexually predatory behavior. However, other studies claim to have not found statistically significant links between the triad and violent offenders.

Further studies have suggested that these behaviors are actually more linked to childhood experience of parental neglect, brutality or abuse. Some argue this in turn results in "homicidal proneness". The "triad" concept as a particular combination of behaviors linked to violence may not have any particular validity – it has been called an urban legend.

Major depressive disorder

Major depressive disorder (MDD), also known simply as depression, is a mental disorder characterized by at least two weeks of low mood that is present across most situations. It is often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause. People may also occasionally have false beliefs or see or hear things that others cannot. Some people have periods of depression separated by years in which they are normal, while others nearly always have symptoms present. Major depressive disorder can negatively affect a person's personal life, work life, or education, as well as sleeping, eating habits, and general health. Between 2–8% of adults with major depression die by suicide, and about 50% of people who die by suicide had depression or another mood disorder.The cause is believed to be a combination of genetic, environmental, and psychological factors. Risk factors include a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse. About 40% of the risk appears to be related to genetics. The diagnosis of major depressive disorder is based on the person's reported experiences and a mental status examination. There is no laboratory test for major depression. Testing, however, may be done to rule out physical conditions that can cause similar symptoms. Major depression is more severe and lasts longer than sadness, which is a normal part of life. The United States Preventive Services Task Force (USPSTF) recommends screening for depression among those over the age 12, while a prior Cochrane review found that the routine use of screening questionnaires has little effect on detection or treatment.Typically, people are treated with counseling and antidepressant medication. Medication appears to be effective, but the effect may only be significant in the most severely depressed. It is unclear whether medications affect the risk of suicide. Types of counseling used include cognitive behavioral therapy (CBT) and interpersonal therapy. If other measures are not effective, electroconvulsive therapy (ECT) may be considered. Hospitalization may be necessary in cases with a risk of harm to self and may occasionally occur against a person's wishes.Major depressive disorder affected approximately 216 million people (3% of the world's population) in 2015. The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France. Lifetime rates are higher in the developed world (15%) compared to the developing world (11%). It causes the second-most years lived with disability, after lower back pain. The most common time of onset is in a person's 20s and 30s. Females are affected about twice as often as males. The American Psychiatric Association added "major depressive disorder" to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. It was a split of the previous depressive neurosis in the DSM-II, which also encompassed the conditions now known as dysthymia and adjustment disorder with depressed mood. Those currently or previously affected may be stigmatized.

Minor physical anomalies

Minor physical anomalies (MPAs) are relatively minor (typically painless and, in themselves, harmless) congenital physical abnormalities consisting of features such as low-set ears, single transverse palmar crease, telecanthus, micrognathism, macrocephaly, hypotonia and furrowed tongue. While MPAs may have a genetic basis, they might also be caused by factors in the fetal environment: anoxia, bleeding, or infection. MPAs have been linked to disorders of pregnancy and are thought by some to be a marker for insults to the fetal neural development towards the end of the first trimester. Thus, in the neurodevelopmental literature, they are seen as indirect indications of interferences with brain development.

MPAs have been studied in autism, Down syndrome, and in schizophrenia. A 2008 meta-analysis found that MPAs are significantly increased in the autistic population. A 1998 study found that 60% of its schizophrenic sample and 38% of their siblings had 6 or more MPAs (especially in the craniofacial area), while only 5% of the control group showed that many.The most often cited MPA, high arched palate, is described in articles as a microform of a cleft palate. Cleft palates are partly attributable to hypoxia. The vaulted palate caused by nasal obstruction and consequent mouth breathing, without the lateralising effect of the tongue, can produce hypoxia at night.

Other MPAs are reported only sporadically. Capillary malformation is induced by RASA1 mutation and can be changed by hypoxia. A study in the American Journal of Psychiatry by Trixler et al.: found hemangiomas to be highly significant in schizophrenia. Exotropia is reported as having low correlation and high significance as well. It can be caused by perinatal hypoxia.


Neurology (from Greek: νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is a branch of medicine dealing with disorders of the nervous system. Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the central and peripheral nervous systems (and their subdivisions, the autonomic and somatic nervous systems), including their coverings, blood vessels, and all effector tissue, such as muscle. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system.

A neurologist is a physician specializing in neurology and trained to investigate, or diagnose and treat neurological disorders. Neurologists may also be involved in clinical research, clinical trials, and basic or translational research. While neurology is a nonsurgical specialty, its corresponding surgical specialty is neurosurgery.Significant overlap occurs between the fields of neurology and psychiatry, with the boundary between the two disciplines and the conditions they treat being somewhat nebulous.


Phenoxypropazine (trade name Drazine) is an irreversible and non-selective monoamine oxidase inhibitor (MAOI) of the hydrazine family. It was introduced as an antidepressant in 1961, but was subsequently withdrawn in 1966 due to hepatotoxicity concerns.


Symphorophilia is a paraphilia in which sexual arousal involves staging and watching a tragedy, such as a fire or a traffic accident.

The term was coined by John Money in his 1984 paper Paraphilias: Phenomenology and classification, formed from the Greek root "συμφορά" ("symphora", event, misfortune):

A special form of sacrificial paraphilia, for which a suitable name is symphorophilia (being erotically turned on by accidents or catastrophes), culminates in an arranged disaster, such as an automobile crash. Like a game of Russian roulette, it may end in death — alone or with the partner. However, flirting with disaster, rather than suicide and murder is the trigger responsible for autoerotic arousal and excitement. Being the daredevil who will live to risk a love-death again is an essential part of this paraphilia.

As a photographic print is the positive made from its negative, so also the positive of self-crashing is arranging for a disaster to occur on the highway, and then watching the carnage from a preselected observation post. Disasters other than on the highway may be arranged — catastrophic fires, for example. For those members of the general public who have a touch of sadomasochism in them, disaster as an unrehearsed event is often a large part of the appeal of entertainment stunts and sports, from the circus to stock-car racing.

Although it does not use the term, a 1960 study in the American Journal of Psychiatry describes a man aroused by being injured by "an automobile operated by a woman".

The Protest Psychosis

The Protest Psychosis: How Schizophrenia Became a Black Disease is a 2010 book by the psychiatrist Jonathan Metzl (who also has a Ph.D. in American studies), and published by Beacon Press, covering the history of the 1960s Ionia State Hospital—located in Ionia, Michigan and converted into the Ionia Correctional Facility in 1986. The facility is claimed to have been one of America's largest and most notorious state psychiatric hospitals in the era before deinstitutionalization.

Metzl focuses on exposing the trend of this hospital to diagnose African Americans with schizophrenia because of their civil rights ideas. He suggests that in part the sudden influx of such diagnoses could be traced to a change in wording in the DSM-II, which compared to the previous edition added "hostility" and "aggression" as signs of the disorder. Metzl writes that this change resulted in structural racism.

The book was well reviewed in JAMA, where it was described as "a fascinating, penetrating book by one of medicine's most exceptional young scholars." The book was also reviewed in the American Journal of Psychiatry, Psychiatric Services, Transcultural Psychiatry, Psychiatric Times, The American Journal of Bioethics, Social History of Medicine, Medical Anthropology Quarterly, Journal of African American History, Journal of Black Psychology, Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, The Sixties: A Journal of History, Politics and Culture.


Xanomeline (LY-246,708; Lumeron, Memcor) is a muscarinic acetylcholine receptor agonist with reasonable selectivity for the M1 and M4 subtypes, though it is also known to act as a M5 receptor antagonist. It has been studied for the treatment of both Alzheimer's disease and schizophrenia, particularly the cognitive and negative symptoms, although gastrointestinal side effects led to a high drop-out rate in clinical trials. Despite this, xanomeline has been shown to have reasonable efficacy for the treatment of schizophrenia symptoms, and one recent human study found robust improvements in verbal learning and short-term memory associated with xanomeline treatment.

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