We know that childhood trauma can scar our patients psychologically—but new research suggests it might actually change their genes.

Psychoanalysis is both a form of treatment and a theory of mind and development. The treatment involves the exploration of the unconscious meaning of symptoms and behaviors. The idea is that many of our patients’—and our own—personality traits and behaviors are governed by unconscious forces.

The diagnosis of conduct disorder started with patients who were generally labeled as “bad kids”—juvenile delinquents, so to speak—and then professionals came to the realization that these kids are not necessarily “bad” but that there may be some kind of psychiatric pathology underlying their actions. In this interview, Akeem Marsh, MD, presents his perspective as a psychiatrist providing diagnostic evaluations, medication management, individual therapy, and treatment planning in a juvenile detention setting in New York City.

Nearly one in three foster children have significant psychiatric problems during their time in foster care—especially those related to trauma and neglect that brought them into the system. This article is a brief primer on how foster care works, and how psychiatrists get involved.

Foster children tend to be over-medicated. Surveys show that foster youth receive 5 times the number of psychotropic medications, frequently three or four simultaneously, as privately insured children. What else, beside medications, can we offer foster children who are often struggling with psychiatric issues and difficult and unfamiliar family environments?

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If a patient comes in and says, “doc, I think I need to go to rehab,” what should you do? Most people think of rehabs as residential facilities, but these days, the term “rehab” includes a broad spectrum of treatment settings, most of which, in fact, are not residential—only 10% of people receiving specialized addiction services go to residential rehab.

What goes on inside a residential rehab program? Inquiring minds would love to know, especially those of us who are treating addicts and counseling concerned family members. Rehab has traditionally been a kind of black box, an opaque entity where addicts enter, and 30 days later exit with an epiphany and a lifelong commitment to sobriety. Until they relapse and go back to another rehab, that is.

There is a wide array of treatment options for patients with various levels of addiction issues, but of those rehab is one of the most well-known. Dr. Willenbring makes the argument that inpatient rehab is not an effective method to combat addiction.