Innovations in clinical neuroscience最新文献

Objective: This case series is an inaugural attempt to provide a feasible management plan for symptoms of dissociative (conversion) disorders among adolescent girls and women using pranayama, a systematic and rhythmic yogic breathing technique. Dissociative disorders are frequently reported among adolescent girls and women across different cultures and states in India. The neurobiology of dissociative disorders is not clearly understood. Hence, there is no effective medication available. There are no scientific reports available on the use of pranayama for dissociative disorders.

Methods: This study presents three female patients (aged 17 years, 26 years, and 14 years) who underwent pranayama therapy instead of conventional management in outpatient settings for four weeks. A pranayama intervention module was designed based on their specific symptoms, using the Dissociative Experiences Measurement Oxford (DEMO) scale. After four weeks, the results were documented, and all three patients were advised to continue the daily practice of pranayama for 30 minutes in the morning and evening.

Results: All three patients reported improvement in breathlessness, restlessness, sleep, focus and concentration, feeling numb and disconnected, memory blanks, and vivid internal world. A follow-up was done after four weeks of completion of the pranayama intervention. No adverse effects were noted during the four weeks of intervention and at follow-up.

Conclusion: This case series testifies to the potential efficacy of pranayama intervention in managing the symptoms of dissociative disorders among adolescent girls and women. Further studies are required on a large sample size to validate the role of pranayama in the management of symptoms of dissociative disorders as an independent intervention.

Objective: In 2019, the authors began implementing a measurement-based care (MBC) curriculum into two residency programs at West Virginia University (WVU) and Delaware Psychiatric Center (DPC). The authors present findings from the four-year implementation period and describe a web-based MBC course that aims to train attendings and residents across the United States (US) and abroad.

Methods: The web-based MBC course includes four readings (the MBC instruction manual, the Standard for Clinicians' Interview in Psychiatry [SCIP] glossary, clinician-administered [CA] scales, and self-administered [SA] scales), four didactic presentations (MBC basics, psychopathology assessment, epidemiological concepts, and psychiatric measures), and four video interviews. The web-based MBC course is accessible through the WVU online continuing medical education (CME) web courses. The modified MBC psychiatry residency training curriculum includes four didactic lectures taught by MBC-trained faculty members and attendings. Residents practice using the scales during their inpatient and outpatient rotations and complete the web-based MBC course before graduation.

Results: The web-based MBC course was used to train most of the attendings in the WVU and DPC residency programs. Both programs now require residents to complete the web-based MBC course before graduation. Of the 52 residents in both programs, 26 residents (50%) had completed the training at the time of writing this article.

Conclusion: The web-based MBC course was successfully implemented in two US residency programs and is now available for clinicians around the world to access. Free access to the SCIP scales will be granted to psychiatry residency programs implementing the MBC curriculum.

Treatment-resistant depression (TRD) is major depression that has not responded to at least two trials of antidepressants. The STAR-D study highlighted the necessity of multiple treatment steps to achieve remission, with each step decreasing the likelihood of success and increasing relapse risk, underscoring the complexity of TRD treatment and the need for personalized approaches. Transcranial magnetic stimulation (TMS) is a noninvasive technique using magnetic fields to stimulate brain nerve cells, targeting the dorsolateral prefrontal cortex, that is effective in many patients with depression. However, for patients with TRD who fail TMS, no standard of care exists. Intranasal esketamine, a noncompetitive N-methyl-D-aspartic acid (NMDA) receptor antagonist, is approved for adults with TRD or major depressive disorder with suicidal thoughts. We present a case series of five patients with TRD who failed TMS and subsequently responded to intranasal esketamine. Response, defined as a 50-percent symptom reduction, was monitored using Patient Health Questionnaire (PHQ-9), Beck Depression Inventory (BDI), and Generalized Anxiety Disorder-7 (GAD-7) scores. After 16 treatment sessions, all patients achieved a treatment response per PHQ-9 and BDI scores; 80 percent achieved complete remission per PHQ-9, and 60 percent per BDI. Additionally, 80 percent of patients showed a treatment response on GAD-7 scores. This case series supports further investigation into esketamine for patients with TRD who are unresponsive to TMS.

This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation and other resources offered to health care providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers might provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other healthcare professionals so "clinician" is used to indicate all treatment team members.

Department editor: Julie P. Gentile, MD, is Professor and Chair of the Department of Psychiatry at Wright State University in Dayton, Ohio.

Editor’s note: The patient scenarios presented in this article are composite cases written to illustrate certain diagnostic characteristics and to instruct on treatment techniques. The composite cases are not real patients in treatment. Any resemblance to real patients is purely coincidental.

Abstract: The prevalence of mental illness in individuals with intellectual disability (ID) is higher compared to the general population. Persons with ID typically have insufficient coping skills and fewer systems of natural support; they are often more vulnerable to stress. There is evidence that level of intelligence is not a sole indicator for appropriateness for psychotherapy, and that the full range of mental health services help improve quality of life for patients with ID. Polypharmacy is more common in patients with co-occurring ID and mental illness. It is common for patients with ID to be prescribed multiple medications for both physical and mental health conditions. In addition, when patients are discharged from state-operated institutions to the community, it is common for them to continue taking the same number of medications. This article will review the use of adapted psychotherapy in patients with ID, as well as deprescribing protocols to address polypharmacy.