Journal of Psychiatric Practice最新文献

Reversible cerebral vasoconstriction syndrome (RCVS) represents a group of conditions that show reversible multifocal narrowing or constriction of the cerebral arteries that supply blood to the brain. The initial manifestation of RCVS often includes a "thunderclap" headache that is sudden, severe, and often disabling. Stimulants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and antipsychotics with serotonergic activity can alter the cerebral arterial tone, trigger vasoconstriction, and place patients at risk of a cerebrovascular accident. Thus, psychiatric medications are commonly discontinued on admission for RCVS, and psychiatry is often consulted for input on acute medication management and longitudinal treatment options. Currently, there is a dearth of literature on managing psychiatric medications in RCVS, resulting in variable practice patterns that place patients at risk of withdrawal, decompensation, and relapse. In this article, we provide a case example and aim to consolidate the limited data surrounding the management of psychiatric illness with comorbid RCVS in our discussion. There is a clear concern about worsening and even potentially lethal consequences due to serotonin or stimulant-induced vasospasm both during an acute episode and in long-term management of RCVS. We discuss the underlying pathophysiologic mechanisms proposed for serotonergic-, noradrenergic-, and dopaminergic-induced cerebral vasospasm and how this correlates with the clinical management of patients on psychiatric medications. These data will then be organized to create a risks versus benefits outline to equip psychiatrists to make decisions about when to stop and when to restart psychiatric medications in the setting of RCVS.

The term "revolving door patients" refers to those who are frequently rehospitalized for relapse. This phenomenon can be explained by a multitude of factors, including a lack of medical and/or social support. On the basis of a review of various modalities of psychiatric treatment, such as long-acting injectables, assisted outpatient treatment, and telehealth, it is clear that a major underlying issue among people with psychiatric diseases who lack insight into their mental and physical health is medication nonadherence. Therefore, we propose a mobile delivery program (MDP) in which health care professionals deliver medications and care to psychiatric patients in their own homes. The target patient population for MDP is patients with medication nonadherence, frequent emergency department visits, and missed appointments. Patients with mental illnesses, especially schizophrenia, are disproportionately represented among the homeless and incarcerated populations. By implementing MDP, we can help break the cycle of incarceration for patients with mental illnesses and homelessness. In addition, the cost of transportation and salaries for the mobile delivery team would be considerably lower than the billions of dollars spent each year due to relapses, emergency department visits, inpatient admissions, and crime leading to long-term stays in correctional facilities. This model has the potential to reduce relapse, improve functioning, and reduce excess morbidity and mortality. Substantial cost savings for health services can, in turn, be expected.

Background: The goal of this study was to evaluate specific characteristics associated with hopelessness, potentially correlated with coping strategies, sensory profile, and alexithymia in patients with borderline personality disorder (BPD).

Materials and methods: Two hundred twenty-four (N=224) inpatients completed a clinical interview with administration of the Beck Hopelessness Scale (BHS), the Adolescent/Adult Sensory Profile (AASP), the Coping Orientation to Problems Experienced Inventory (COPE), and the Toronto Alexithymia Scale (TAS).

Results: Hopelessness was significantly associated with female gender, more hospitalizations, current suicidal ideation, number of suicide attempts, current and lifetime medication abuse, and alcohol misuse. Furthermore, patients with BHS ≥ 9 had higher scores in low registration, sensory sensitivity and sensation avoiding in AASP, higher rate of alexithymia, and the use of maladaptive coping strategies.

Conclusions: Hopelessness in BPD was associated with higher severity of illness, alternative process sensory input from the environment, reduced ability to cope with stressful events, and alexithymia. Therefore, a routine assessment of hopelessness in patients with BPD could lead to better and more specific therapeutic strategies.

Psychotherapy remains a scarce resource for patients, as problems such as provider shortages result in waitlists and lack of timely access. In their academic medical center outpatient clinic, the coauthors piloted use of a therapist-guided CBT website, Good Days Ahead, in routine clinical practice. They reflect on the benefits and challenges of this approach in this guest column.

Misophonia is characterized by decreased tolerance to idiosyncratic and repetitive human-generated sounds (ie, triggers), coupled with affective-based reactions that result in impairment and distress. Often having its onset in youth, misophonia can become especially prominent during key developmental periods, including emerging adulthood. While efforts to develop interventions for misophonia remain ongoing, a consensus has not yet been reached concerning recommended first-line treatments. Acceptance and commitment therapy (ACT), which has demonstrated efficacy in treating various psychiatric disorders via targeting psychological flexibility processes, represents one potentially feasible approach for addressing misophonia. This case study describes the application of an individually delivered, 12-session ACT intervention for a black female in her early 20s with misophonia. Descriptive data collected at 4 time points (pretreatment, mid-treatment, posttreatment, and at 2-month follow-up) suggested the potential promise of ACT as a treatment for misophonia, improving psychological flexibility processes and reducing secondary depression and anxiety symptoms. Findings are discussed in the context of the possible mechanisms of ACT most likely responsible for misophonia-related clinical improvement. More rigorous studies (eg, clinical trials) are needed to confirm promising findings from existing case studies.

This column is the third in a 3-part series describing cases in which general medical knowledge, including psychiatric and clinical pharmacology, was instrumental in determining whether dereliction was the direct cause of damages in a malpractice suit. This case illustrates how not taking into account the following variables can result in a false-positive diagnosis of a lethal serotonin syndrome: (a) the time course of treatment, (b) the time course of symptoms, (c) the difference between antemortem plasma and postmortem whole-blood levels of highly protein bound and highly lipophilic drugs. The case also illustrates how taking those 3 variables into account led to the conclusion that there was no dereliction in the care of the patient that was the direct cause of his death, and hence, there was no medical malpractice.

Objective: The goal of this study was to examine the psychological and physical effects experienced by health care workers (HCWs) participating in the response to the February 2023 earthquakes in Turkey and to identify any associated factors.

Methods: An online survey was used to collect data from HCWs on duty in earthquake-stricken areas. The following assessment tools were utilized: Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Maslach Burnout Inventory, Posttraumatic Growth Inventory, and Short Form-12.

Results: A total of 175 HCWs with a mean age of 37.27 years participated in the study. Of these, 39.4% suffered from PTSD, 30.3% experienced depression, and 31.4% experienced anxiety. Female gender, loss of significant others, and previous psychiatric treatment were found to be associated with worse mental health. Nurses tended to have higher levels of PTSD than the medical doctors; the medical doctors had significantly lower scores on the Posttraumatic Growth Inventory compared with the nurses and the other HCWs and lower mental component summary scores on the Short Form-12 compared with the other HCWs. Meeting basic needs and subjective evaluation of teamwork were also linked to mental health. The study also found that marital status, age, and length of time spent in earthquake-stricken areas were associated with scores on the Maslach Burnout Inventory.

Conclusions: After the earthquake in Turkey, HCWs experienced a significant amount of various adverse mental health outcomes related to certain demographic variables such as gender, profession, previous psychiatric treatment, loss of relatives, and evaluation of living conditions and teamwork. Since HCWs play an essential role in reducing the harmful effects of disasters, recognizing groups at risk and planning tailored interventions may help prevent mental health issues.