Journal of Psychiatric Practice最新文献

We report a patient with cerebral venous thrombosis who initially presented with psychosis and who then progressed to delirium and catatonia within a few days. Upon treatment and resolution of the thrombosis, she presented complete remission of the psychiatric disturbances. This case highlights a specific neuropsychiatric presentation of cerebral venous thrombosis involving psychosis, catatonia, and delirium, which, to our best knowledge, has not been reported in the neurological or psychiatric literature. However, it reminds us of mental status and behavioral abnormalities which are not infrequent features of cerebral venous thrombosis. This leads to a discussion regarding the psychopathology, etiology, and pathophysiology of the case.

This column explores the challenges involved in providing psychotherapy through artificial intelligence. It reviews artificial intelligence's capacity across schools of therapy to address relevant issues related to privacy, the use of technical interventions, and the therapeutic relationship.

Clomipramine (CIMI) is an effective treatment for obsessive-compulsive disorder in patients who have failed to respond to trials of selective serotonin transport inhibitors (eg, sertraline). The case presented here illustrates how knowledge of the pharmacodynamics and pharmacokinetics of CIMI in a specific patient can be used to personalize treatment to optimize the likelihood of efficacy (ie, maximum benefit to risk ratio). The approach described in this column considered: (1) the patient's diminished ability to clear CIMI and its major metabolite, desmethlyclomipramine due to a genetic deficiency in cytochrome P450 2D6 enzyme activity, and (2) the patient's ability to extensively convert CIMI to desmethlyclomipramine. That conversion impairs the ability to inhibit the serotonin transporter, the mechanism that is most likely responsible for the efficacy of CIMI in obsessive-compulsive disorder.

Reproductive control or reproductive coercion has negative health consequences but has not been systematically studied within the context of sex trafficking. Our goal is to identify the range of methods used by sex traffickers and buyers to control the reproductive choices of trafficked women and to provide specific examples of these methods. We searched PubMed, Embase, and PsycInfo using the terms "reproductive control" or "reproductive coercion" and "human trafficking" or "sex trafficking," including papers that contained original, specific examples of reproductive control occurring within the context of sex trafficking. These reports were described and categorized into established domains of reproductive control. Eight articles were located that met our inclusion criteria, of which 6 described outcomes of birth control sabotage, 2 described pressuring into pregnancy, 5 described controlling the outcome of a pregnancy, and 2 described forced birth control or sterilization. Our findings have implications for how to take sexual histories and for identifying and assisting trafficked persons.

Clinicians treating "very important persons" face potential problems that can negatively impact the quality of care they provide. Mental health professionals face similar pressures, particularly when asked to treat a particular kind of patient who is a very important person: medical colleagues or their family members. The authors present 3 cases that exemplify possible risks associated with the psychiatric treatment of these individuals, including negative effects on the physician-patient relationship, lapses in patient confidentiality, and violations of medical ethics. Preventive and mitigative steps to avoid these pitfalls are discussed. Awareness of these issues when treating fellow physicians or their family members is an important consideration for any mental health clinician.

Objective: The goals of this study were to investigate whether there was a dominant temperament type, and to assess the effect of temperament, pain catastrophizing, and anxiety sensitivity on pain severity, in female patients diagnosed with chronic pelvic pain (CPP) compared with healthy controls.

Methods: This cross-sectional study involved 51 patients 18 to 65 years of age who were diagnosed with CPP without a history of psychiatric treatment and 97 healthy volunteer women with sociodemographic characteristics similar to those of the study group. A sociodemographic form prepared by the researchers, the Anxiety Sensitivity Index, the Pain Catastrophizing Scale, a temperament scale (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire), and a visual analog pain scale (VAS) were completed. The results were compared between the patient and control groups. Multiple regression analyses were performed to examine the predictive effects of temperament characteristics, pain catastrophizing, and anxiety sensitivity on pain severity.

Results: Scores on the Pain Catastrophizing Scale and the VAS were statistically significantly higher in the CPP group ( P <0.001). The frequency of depressive, cyclothymic, and irritable temperaments was found to be significantly higher in the CPP group (CPP: 7.78±3.32 vs. controls: 6.54±3.19; P =0.027; CPP:10.61±4.41 vs. controls: 8.82±4.21; P =0.017; CPP: 5.22±4.29 vs. controls: 3.75±3.41; P =0.025). According to the model established by temperament traits, anxiety sensitivity, and pain catastrophizing level, pain catastrophizing level explained 11.6% of the variance in pain severity. A 1-unit change in the score for pain catastrophizing level caused a 0.278-point change in the VAS total score ( P <0.01).

Conclusions: Cyclothymic, depressive, and irritable temperament types that increase the risk of affective disease are more common in patients with CPP. The level of pain catastrophizing in patients with CPP affects their perception of the severity of the pain.

Background: Cardiovascular disease is one of the leading causes of premature death in people with schizophrenia. Some modifiable factors that have been implicated include unhealthy lifestyle, medication side effects, and physical comorbidities. The goal of this study was to assess the efficacy of a 6-month, multifactorial cardiovascular risk intervention to reduce cardiovascular risk (CVR) in people with schizophrenia.

Methods: We conducted a 2-arm, parallel, randomized clinical trial in a regional mental health center. Participants with at least 1 poorly controlled cardiovascular risk factor (CVRF) (hypertension, diabetes mellitus, hypercholesterolemia, or tobacco smoking) were randomly assigned to the intervention group or to a control group. The subjects in the intervention group received a patient-centered approach that included promoting a healthy lifestyle, pharmacological management of CVRFs, psychotropic drug optimization, and motivational follow-up [Programa d'optimització del RISc CArdiovascular (PRISCA)]. The main outcome was change in CVR as assessed using the Framingham-REGICOR function, after 6 months compared with the baseline in both groups.

Results: Forty-six participants were randomly assigned to the PRISCA group (n=23) or the control group (n=23). The most prevalent CVRFs at baseline were hypercholesterolemia (84.8%) and tobacco smoking (39.1%). The PRISCA group showed a significant reduction in the REGICOR score (-0.96%; 95% CI: -1.60 to -0.32, P=0.011) after 6 months (relative risk reduction of 20.9%), with no significant changes in the control group (0.21%; 95% CI: -0.47 to 0.89, P=0.706). In the PRISCA group, low-density lipoprotein cholesterol also decreased significantly (-27.14 mg/dL; 95% CI: -46.28 to -8.00, P=0.008).

Conclusion: A patient-centered, multifactorial cardiovascular risk intervention improved CVR in people with schizophrenia after 6 months, which was achieved mainly by improving the lipid profile.