Journal of Psychiatric Practice最新文献

Clozapine, an antipsychotic medication for treatment-resistant schizophrenia, remains underutilized due to its serious side effects and need for extensive hematologic monitoring. Recently, discussions have focused on the use of point-of-care testing (POCT) devices to monitor laboratory values, including the absolute neutrophil count (ANC) and clozapine concentration, in patients being treated with clozapine. This review assesses whether these devices could ease the monitoring burden on patients and providers without compromising the accuracy of results and subsequent patient safety. We found several devices that are reported to have acceptable accuracy for the initial screening of ANC and clozapine concentration. Although confirmatory standard venous testing is sometimes required based on point-of-care results, these devices offer results more quickly than traditional methods, increasing utility for clinicians. Further research is needed to evaluate the performance of these devices in diverse patient populations, including individuals with benign ethnic neutropenia and those susceptible to diurnal variation of ANC.

Based on survey feedback, ~5% of prescribers do not understand the importance of the prescribing information (PI) provided by the U.S. Food and Drug Administration (FDA) and the specific manufacturer of the drug, even though it is provided every time the drug is dispensed. This column addresses 3 representative comments from this subset of prescribers about whether it is an appropriate expectation that the prescriber be familiar with the PI, whether by reading it in its entirety or the first page summary and any additional sections that they wish to know. It also discusses that many, if not all, prescribing "guides" are in fact the PI reformatted for the guide. This column refers the reader back to earlier columns that discuss some of these matters in more detail. This column also addresses comments by 8% of surveyed prescribers about the need for training programs to cover this information for the benefit of prescribers in training and their eventual patients.

Psychiatrists increasingly practice psychotherapy by integrating their therapeutic training into brief medication visits. Insurance companies reimburse this approach using the 90833 Current Procedural Terminology (CPT) code, which corresponds to 16 to 37 minutes of add-on psychotherapy combined with pharmacotherapy. As scholarship focused on such short-form combined therapy is scarce, this 4-part series addresses the practice gap, providing guidance to practicing professionals. This installment addresses psychodynamic psychotherapy, a deeply personalized intervention that is increasingly recognized as a modality well suited to integration with psychopharmacology.

Morgellons disease is a rare and controversial disorder characterized by the perception of fiber-like structures in the skin and bodily sensations such as itching and crawling due to them. Patients may cause wounds by trying to remove nonexisting objects they sense. Some practitioners suggest that the disease may be associated with infectious pathogens. However, most clinicians and studies support the hypothesis that the disease is a form of delusional parasitosis. Patients with Morgellons disease, similar to those with delusional parasitosis, have fixed beliefs about foreign bodies on their skin and lack insight into their disease. Morgellons disease has predominantly been described in the dermatology literature, while it has received limited attention in the psychiatry literature. We report the case of a female patient who reported complaints of "hairy, wire-like" structures that appeared with sweat on her body. This patient was referred to psychiatry after initially presenting to the dermatology and ophthalmology clinics. The patient was diagnosed with Morgellons disease and treated with olanzapine. Morgellons disease is considered a form of delusional parasitosis; however, it is not recognized enough by psychiatrists due to the fact that patients mostly present at nonpsychiatric clinics. Therefore, the goal of this report is to increase awareness about Morgellons disease among clinicians, particularly psychiatrists.

Objective: This study validated embedded symptom validity tests (SVT) in the Beck Depression (BDI-II) and Beck Anxiety (BAI) Inventories that are sensitive to psychiatric symptom overreporting in an outpatient clinical population referred for attention-deficit/hyperactivity disorder diagnostic evaluation.

Methods: Cross-sectional data from 623 consecutive neuropsychological referrals were analyzed. The sample comprised young-to-middle-aged community-dwelling adults, was predominantly female (61%), and 44% non-Hispanic white, 25% Hispanic, 16% non-Hispanic black, 10% Asian, and 5% other race/ethnicity.

Results: BDI-II ≥ 26 (33% to 86% sensitivity/90% specificity) and BAI ≥ 16 (38% to 82% sensitivity/90% specificity) were optimal cut-scores for detecting potential symptom overreporting. Scores exceeding the cutoffs on both the BDI-II and BAI SVTs should be counted as a single elevation, because these tests captured redundant aspects of overreporting. However, the BDI-II SVT was the stronger symptom overreporting indicator and should be prioritized as the more accurate test when BDI-II/BAI SVT discrepancies occur.

Conclusions: BDI-II and BAI embedded SVTs can detect possible symptom overreporting among diagnostically diverse outpatients undergoing attention-deficit/hyperactivity disorder evaluations. These SVTs are not intended to replace well-validated SVTs, but screen for symptom overreporting and identify patients who may require further assessment without incurring additional time, costs, or burden, as they are embedded in brief, routinely administered self-report measures.

Suicide among older adults is a critical yet often overlooked public health concern, with this population exhibiting the highest suicide rates globally. This article explores the multifaceted factors contributing to suicide in older adults, including depression, loneliness, chronic illness, financial stress, and a loss of purpose. It also addresses challenges in identifying and preventing suicide, such as stigma, limited access to mental health services, and misclassification of cases. Current prevention strategies, including screening tools like the Geriatric Depression Scale, integrated care models, and community-based interventions, are discussed alongside ethical debates surrounding autonomy in end-of-life decisions. The article highlights critical research gaps in understanding how various social, cultural, and economic factors intersect to influence suicide risk in older adults. It underscores the need for longitudinal studies and culturally tailored interventions, particularly leveraging telehealth solutions to improve access to care. Recommendations for primary care physicians include enhancing suicide risk screening, fostering collaboration with mental health specialists, and leveraging community resources to reduce isolation. By adopting a comprehensive and collaborative approach, health care providers, researchers, and policymakers can address the unique needs of this vulnerable population and work toward reducing suicide rates among older adults.

Objective: This study investigates the medium-term effects of an intensified inpatient dialectical behavior therapy (DBT) program on psychosocial outcomes and predictors of response in patients with borderline personality disorder (BPD). While the effectiveness of DBT is well established, insights into psychosocial outcomes after inpatient treatment remain limited.

Methods: All 115 patients with BPD who participated in an 8-week inpatient DBT program at a university hospital in southern Germany in 2021 and 2022 were evaluated. Psychopathological changes were assessed using the short version of the Borderline Symptom List (BSL-23). Sociodemographic data and data on psychosocial functioning were collected using questions from the Indications of Rehabilitation Status Score (IRES-3) questionnaire before treatment, as well as at a 6-month follow-up. BSL-23 data were also assessed after treatment. To examine predictors of response to therapy, categorical pre-post comparisons as suggested by Jacobson and colleagues were applied to the BSL-23.

Results: Eighty percent of the patients (n=92) completed the therapy. The patients who completed therapy were older than the dropouts. Significant reductions in BPD symptoms (BSL-23) were observed posttreatment (n=83) and at the 6-month follow-up (n=35). Effect sizes were large posttherapy (Cohen's d=0.837) and remained moderate after 6 months (d=0.460). With regard to psychosocial functioning, patients reported increased social support, fewer concerns about social relationships, and higher life and job satisfaction 6 months after therapy. Higher educational attainment was a significant predictor of treatment response.

Conclusions: The intensified inpatient DBT program described in this article led to significant and sustained reductions in symptoms and improvements in psychosocial outcomes in patients with BPD. Educational levels and age at treatment onset may be critical factors for successful treatment.