Journal of Psychiatric Practice最新文献

Ciprofloxacin is an antibiotic from the fluoroquinolone group that is frequently used in many clinical practices. In addition to its peripheral neuropathic side effects, it is an antibiotic that can pass through the blood-brain barrier due to its lipophilic features and cause rare central nervous system symptoms. Although cases of neuropsychiatric symptoms developing after treatment with ciprofloxacin have been reported in the literature, the number of reports of manic episodes after ciprofloxacin use is limited, and there have been no reports of delirious mania developing after ciprofloxacin use until the case presented in this report. Here we report the case of a 52-year-old woman who developed manic symptoms after receiving ciprofloxacin, which evolved into delirious mania. Clinical factors that may predispose to neurotoxicity are discussed and compared with features of the mania cases in the literature. The underlying neurobiological mechanisms are also reviewed.

Objective: Subjective cognitive complaints are common among patients presenting for evaluation of attention-deficit/hyperactivity disorder (ADHD). Despite these complaints, research overwhelmingly suggests that reported cognitive deficits do not align with objective neurocognitive performance. This study explored the relationship between subjective cognitive complaints, objective neuropsychological functioning, and performance and symptom validity testing in adult patients referred for evaluation due to concern about ADHD.

Methods: The sample consisted of 523 adult referrals who underwent comprehensive evaluation for concern about ADHD and to characterize cognitive strengths and weaknesses. Four hundred patients were diagnosed with ADHD, and 123 did not meet the diagnostic criteria for ADHD. Patients were dichotomized to form nonelevated (n=134) and elevated (n=389) cognitive complaint groups, which were compared on objective neurocognitive performance, report of ADHD-specific symptoms, and performance validity tests.

Results: Significant differences were identified between the elevated and nonelevated cognitive complaints groups in performance validity tests and ADHD symptom reporting; however, clinical differences were not identified on objective neurocognitive measures.

Conclusions: Consistent with the results of previously published research, subjective cognitive complaints did not align with objective neurocognitive deficits in a sample of adult ADHD referrals. Elevated cognitive complaints were associated with higher rates of performance validity failure and invalid ADHD-specific symptom reporting. These findings highlight the importance of assessing cognitive complaints using symptom report inventories and cognitive tests that include objective validity indices.

Recently, the field of psychiatry has experienced a transformative shift with the integration of digital tools into traditional therapeutic approaches. Digital psychiatry encompasses a wide spectrum of applications, ranging from digital phenotyping, smartphone applications, wearable devices, virtual/augmented reality, and artificial intelligence (AI). This convergence of digital innovations has the potential to revolutionize mental health care, enhancing both accessibility and patient outcomes. However, despite significant progress in the field of digital psychiatry, its implementation presents a plethora of challenges and ethical considerations. Critical problems that require careful investigation are raised by issues such as data privacy, the digital divide, legal frameworks, and the dependability of digital instruments. Furthermore, there are potential risks and several hazards associated with the integration of digital tools into psychiatric practice. A better understanding of the growing field of digital psychiatry is needed to promote the development of effective interventions and improve the accuracy of diagnosis. The overarching goal of this review paper is to provide an overview of some of the current opportunities in digital psychiatry, highlighting both its potential benefits and inherent challenges. This review paper also aims at providing guidelines for future research and for the proper integration of digital psychiatry into clinical practice.

Catatonia is a neuropsychiatric syndrome affecting movement, emotion, speech, and behavior, which commonly occurs secondary to medical or psychiatric disorders and with comorbid illnesses. We report the case of an 18-year-old male with a history of depression, anxiety, attention-deficit/hyperactivity disorder, polysubstance use, and previous suicide attempts who presented to the hospital from a residential eating disorders treatment facility, due to psychomotor slowing. The patient scored 3 or lower on the Bush-Francis Catatonia Rating Scale (BFCRS), but he showed marked improvement following 2 mg of intravenous lorazepam. The patient was referred for ECT, experienced dramatic improvement, and was discharged at his baseline functioning. His discharge diagnosis was catatonic syndrome secondary to severe melancholic depression. Catatonia may present a diagnostic challenge as no single catatonia screener captures all possible phenotypes. The patient consistently scored low on the BFCRS but he had a clear response to standard-of-care catatonia treatment. Psychomotor slowing is common in catatonia but is not designated as a catatonic feature in either the DSM-5 or the BFCRS. This case also presented diagnostic complexity as the patient initially presented with malnutrition and concern about a possible eating disorder. This report highlights that diagnosing catatonia is challenging, particularly in the context of medical complexity, and that there are discrepancies between diagnostic tools. When suspicion of catatonia is high, despite low individual screening scores, clinicians may consider alternative screening instruments or empiric treatment.

This column addresses the role of dreams in psychoanalysis and psychodynamic therapy. It includes an autobiographical perspective on how a dream led this psychiatrist to become a psychoanalyst and an introduction to social dreaming.

The Level of Personality Functioning Scale (LPFS) was introduced in DSM-5 to articulate a conceptual foundation for all types of personality psychopathology, and to provide an assessment of the severity of impairment. Constructed using universal human capacities related to self- and interpersonal functioning, the LPFS defines a continuum of 5 levels ranging from optimal functioning to extreme impairments in functioning. While there have been a growing number of empirical studies demonstrating its reliability and validity, the LPFS was designed fundamentally as an informative clinical tool, potentially useful to practitioners working in a variety of roles using diverse interventions. This article addresses the issue of treatment utility from 2 particular perspectives. First, we illustrate how the capacities targeted by the LPFS offer a framework for treatment, applicable to a variety of theoretical or methodological orientations. We illustrate that the different facets of the LPFS may provide general aims for treatment by identifying the pathways through which change is realized in (whatever) psychotherapy. Second, we suggest how the levels of functioning may inform pathways toward change by providing information useful for treatment assignment and planning, such as the therapist's stance, the types of intervention, and specific goals in treatment. Through discussing these issues while using brief clinical vignettes, we hope that this article may stimulate clinicians to use the LPFS and discover its value in clinical practice.

Intentional overdose with semaglutide is an infrequently reported phenomenon. We present the case of a 39-year-old transgender male-to-female who attempted suicide by an intentional overdose of semaglutide (Ozempic). Her symptoms after the overdose were mild and self-limiting in nature. This finding reflects positively on the safety profile of the frequently prescribed weight-loss and diabetes medication, Ozempic.

Purpose of review: Provider shortages and other barriers to traditional mental health care have led to the development of technology-based services designed to enhance access and improve the efficiency and convenience of treatment. We reviewed research on computer-assisted cognitive behavior therapy (CCBT) and mobile mental health applications to assess the effectiveness of these methods of delivering or augmenting treatment, evaluating patient and provider uptake, and making recommendations on the clinical use of these tools in the treatment of depression and anxiety.

Results: Research on CCBT has found solid evidence for efficacy when the use of a therapeutic computer program is supported by a clinician or other helping professional. Lower levels of efficacy have been found when CCBT is used as a stand-alone treatment. Current CCBT programs have many desirable features; however, few of the current programs incorporate services such as artificial intelligence that have the potential to help improve communication with patients. An increasing number of mobile apps have been created that claim to be useful for depression and/or anxiety, yet caution is warranted before using most due to limited research on effectiveness, low retention rates, and other issues like safety concerns.

Summary: Growth in the development of CCBT and mental health applications for depression/anxiety has provided several tools that could enhance treatment delivery. A large number of randomized, controlled trials have documented the effectiveness of CCBT, while research on mobile apps has been much less robust. The advantages and disadvantages of these digital technologies are identified, and recommendations are made for clinical use.

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is one of the most commonly used instruments for assessing and quantifying the presence and severity of obsessive-compulsive disorder (OCD) symptoms. Both the interview and self-report (SR) versions of the original Y-BOCS have demonstrated good psychometrics. However, areas for revision were noted regarding the measure's severity ceiling and a "resistance to obsessions" item that did not perform adequately in psychometric testing and was not consistent with theoretical models of OCD. The Y-BOCS-II was thereby created to address these concerns. While the interview has demonstrated strong psychometrics, psychometric evaluation of the self-report version is currently nonexistent. In a sample of 63 adult patients seeking outpatient treatment for OCD (66.7% female, 77.8% white, and 17.5% Hispanic or Latine), we examined the psychometric properties of the Y-BOCS-II-SR, including the level of agreement with the Y-BOCS-II items, subscales, and severity qualifiers, as well as its internal consistency, and its convergent validity with measures of OCD, functional impairment, and quality of life. As expected, the Y-BOCS-II-SR demonstrated strong psychometric properties and expected overlap with responses obtained using the Y-BOCS-II. The findings provide strong initial support for the psychometric properties of the Y-BOCS-II-SR and suggest that it is an efficient and effective option to measure OCD severity.

The relationship between the scientific method and clinical practice was discussed in an earlier column. Another column described the application of analog scales to clinical practice. This column will discuss how the combination of these 2 strategies can be used to increase the efficiency and completeness of outpatient psychiatric management.