Journal of Psychiatric Practice最新文献

Pseudologia fantastica (PF), also known as pathologic lying, compulsive lying, or mythomania, is a rare psychiatric syndrome involving enduring falsifications with extraordinarily colorful and detailed narratives. There is a limited amount of literature on PF, and it remains a challenge for clinicians to diagnose and manage. We present a case of PF with a focus on clinical features and management strategies. The literature on PF is reviewed using the PubMed database. Management strategies reported in previous case reports were successfully adapted for this patient. This report describes the clinical presentation of an individual with PF who experienced a range of psychiatric presentations and had a favorable response to psychotropic medication. Management of such patients should include collaborative effort from treatment teams to provide supportive listening and focus on building rapport with patients. Recognition of PF does not preclude other psychiatric conditions, and any coexisting psychiatric conditions should be treated following current guidelines.

Digital mental health interventions for inpatient psychiatry show promise in improving outcomes. We provide a narrative literature review of studies that examined technology use and outcomes in patients admitted to inpatient psychiatric settings. Overall, the studies demonstrated that technology-smartphones, wearables, tablets, apps-are feasible for use by and acceptable to patients who are receiving mental health care in inpatient psychiatric settings. Given its acceptability, technology offers another strategy and tool for implementing evidence-based practices (eg, psychotherapies) as well as for translating science (eg, findings regarding neuroscience and psychophysiology) into direct practice in inpatient psychiatric settings, ultimately improving outcomes.

Immigration is considered a general risk factor for psychotic disorders, and migrants with a history of trauma exposure are likely to be at an elevated risk of developing psychosis. This is increasingly important with recent political instability, war, and violent trauma creating a wave of new refugee populations worldwide. The Afghan population has a particularly high rate of trauma exposure and also has a high rate of experiencing psychotic symptoms, yet Afghan refugees are the least likely to use antipsychotics compared with other refugee groups. This case report highlights the presentation of an Afghan immigrant who developed a first episode of psychosis shortly after mid-life migration following recent war trauma. The patient was treated and responded well to a long-acting injectable antipsychotic.

Psychiatrists frequently incorporate strategies learned in their psychotherapy training into medication visits. This final installment in a 4-part series focuses on the integration of pharmacotherapy and cognitive-behavioral therapy (CBT), which is the most extensively studied form of psychotherapy for depressive and anxiety disorders. Evidence supporting the value of combined treatment (as compared with pharmacotherapy alone) is strong, but these data come almost exclusively from studies in which the 2 components of treatment were delivered by separate providers. Data are sorely lacking for the integrated approach described in this paper. We hope that the apparent face validity of this approach is evident and helps to foster a new generation of pragmatic research addressing issues that are truly relevant to the contemporary practice of psychiatric medicine, including the possibility that it is more cost-effective when a single provider delivers both modalities.

Background: Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder that significantly impairs quality of life and is commonly associated with psychological factors. This study explores the mediating role of negative meta-emotions, defined as emotional responses to one's own emotions (eg, shame about anxiety), in the relationship between IBS symptom severity, perceived stress, cognitive bias, and hostile attribution.

Participants and procedure: This descriptive-correlational and cross-sectional study was conducted in 2024 and involved 300 patients with IBS, 18 to 60 years of age, who were attending gastroenterology clinics in Tabuk, Saudi Arabia. Participants completed a set of validated questionnaires, including the Hostile Attribution Scale, Perceived Stress Scale, Negative Meta-Emotions Scale, Cognitive Bias Questionnaire, and the IBS Symptom Severity Scale (IBS-SSS). Data were analyzed using SPSS and AMOS. Structural equation modeling was used to examine both direct and indirect effects.

Results: Perceived stress (β=0.42), hostile attribution (β=0.30), and cognitive bias (β=0.35) had significant direct effects on IBS symptom severity. Negative meta-emotions significantly mediated the effects of all 3 variables, with perceived stress showing the strongest total effect (β=0.56). Model fit indices confirmed a good fit (root mean square error of approximation=0.047, comparative fit index=0.94).

Conclusions: The findings highlight the critical role of negative meta-emotions in intensifying IBS symptoms and support the integration of psychological interventions, especially those targeting stress reduction, emotion regulation, and cognitive restructuring, into standard IBS care. Further longitudinal studies are recommended to clarify the temporal order and causality of these psychological influences.

Treatment-resistant depression (TRD) remains a relevant issue in psychiatric practice, driving the exploration of innovative therapeutic alternatives. Ketamine and its enantiomer, esketamine, are emerging as treatments known for their effectiveness as rapid-acting antidepressants. Although previous comparative studies have highlighted some differences in their effects, they did not concurrently evaluate these 2 therapies in the same patient. The goal of this case series is to extend this investigation by comparing the efficacy of ketamine and esketamine in the same patient. This study included 5 patients diagnosed with TRD who had previously received treatment with intravenous ketamine as inpatients on the Mood Disorder Unit at San Raffaele Hospital in Milan. The patients subsequently underwent intranasal esketamine treatment as outpatients due to relapse. All patients received routine oral antidepressant therapy during both episodes, including selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors. The depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) before the first administration of each treatment (T0) and after 6 infusions of ketamine (3 wk) or after 8 administrations of esketamine (4 wk), respectively (T1). Four of the 5 patients showed a clinical response to intravenous ketamine, but only 1 patient showed a clinical response to intranasal esketamine (with clinical response defined as a 50% reduction in MADRS score). In particular, a better response to ketamine did not predict a good response to esketamine. Conversely, the only patient who did not respond to ketamine showed a good response to esketamine. All of the patients showed a significant and rapid reduction in MADRS scores after both treatments, but none of the patients achieved remission with either treatment (defined as a MADRS score<10). Findings from this case series suggest that both ketamine and esketamine are associated with significant reductions in depressive symptoms in TRD. We observed a generally better response to ketamine than to esketamine. This difference may be due both to the pharmacological effects of the R-ketamine (arketamine) component of intravenous ketamine and to the different settings in which the 2 treatments were administered (inpatient vs. outpatient). A better response to ketamine was not predictive of a better response to esketamine in our case series. A deeper insight into the side effects of the treatments (eg, dissociation) and into the clinical history of the patients would be helpful in better understanding the relationship between the 2 treatments.

Misophonia is a recently recognized condition characterized by extreme intolerance of idiosyncratic and repetitive sounds (often human-generated gustatory or breathing-based noises), coupled with intense affective-based reactions, that results in significant impairment and distress. Cognitive-behavioral therapy approaches, including exposure principles and stress management/distress tolerance skills, have demonstrated promise for the treatment of misophonia. However, efforts to develop interventions remain ongoing and further empirical examination of candidate treatment models is needed. In the pilot study described in this article, we preliminarily examined the efficacy of exposure and stress management therapy (ESMT) individually delivered via synchronous telehealth modality for adults with misophonia. Data from 26 participants (mean age=34.4 y) enrolled between April 2016 and September 2020 provided initial support for ESMT on the basis of pretreatment to post-treatment reductions in misophonia symptomology and increases in distress tolerance. Gains were generally maintained at 3- and 6-month follow-ups. The results did not appear to differ based on the order in which the exposure and stress management modules were delivered, which was randomized across participants. Participant perceptions of ESMT homework regarding adherence, comprehension, and usefulness were generally acceptable. This study provides preliminary support for ESMT as a potentially viable psychosocial intervention for misophonia and highlights the promising roles of exposure (with appropriate adaptations) and stress management for alleviating misophonia-related distress and impairment. Findings are discussed in the context of continuing to develop, refine, and test ESMT using more rigorous methodologies and diverse samples.

In this report, we describe an unknown patient who presented to the emergency department with severe catatonia and a constellation of symptoms indicative of a primary psychotic disorder. Simultaneously, the patient exhibited severe autobiographical memory impairment suggestive of a comorbid dissociative disorder. Our report offers insight into a rare instance in which catatonia, a primary psychotic disorder, and dissociative disorder may have intersected in a clinical case. While the patient was successfully treated with lorazepam for his catatonia, his psychotic symptoms responded only minimally to several antipsychotic trials. Ultimately, his psychotic symptoms, disorganized speech and behavior, and autobiographical memory impairment were refractory to treatment, including dual clozapine-risperidone therapy. Remarkably, the patient scored an 8/30 on the Montreal Cognitive Assessment with multidomain deficits in executive function, naming, delayed recall, language, and abstraction. Finally, the patient demonstrated limited vocabulary in his native language, consistent with low educational attainment. Based on his presentation and hospital course, a differential diagnosis, which included unspecified primary psychotic disorder with catatonia, dissociative amnesia, neurodevelopmental disorder, and cognitive malingering, was proposed. The findings from this case highlight the occurrence of co-existing psychotic and dissociative disorders with multidomain neurocognitive deficits and clinical challenges in treating these cases.

Encouraging changes in firearm-related storage practices through lethal means safety (LMS) counseling can be challenging. Motivational interviewing (MI) may be a useful clinical approach for clinicians who deliver LMS counseling. The aim of this 2-part series is to provide clinicians with guidance on applying MI strategies to evoke motivation for changing firearm storage practices. In part 1 of this series, we provide a rationale for considering an MI-based approach to facilitate secure firearm storage practices and briefly review the relational foundations of MI that are critical to successful MI-based interventions (ie, how we approach our patients). In part 2 of this work, we will discuss how MI technical strategies may be applied to LMS counseling to facilitate secure firearm storage practices.