Journal of Psychiatric Practice最新文献

Korean Americans have one of the highest rates of depression of the Asian subgroups in the United States, and they have culture-related factors that affect their mental health. It is important for health care providers to understand the cultural considerations of Korean Americans to better address their mental health. This review article delves into the pertinent cultural practices of Korean Americans for navigating discussions of mental health. We note the cultural views, language barriers, historical traumas, and immigration challenges of Korean Americans, and we consider the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision's discussion of Koreans. We also include a table of Korean mental health terms with cultural significance and a list of online resources tailored for Korean Americans. In addition, we discuss the unique experiences of North Korean refugees that affect their mental health. Overall, this review informs health care providers about cultural considerations for navigating discussions of mental health with Korean Americans.

Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune neuromuscular junction disorder characterized by proximal weakness, autonomic dysfunction, and areflexia associated with antibodies against voltage-gated calcium channels (VGCCs). Psychotic symptoms can occur in many autoimmune neurological disorders but they have rarely been observed in myasthenic syndromes. We report the case of a 21-year-old woman with primary autoimmune LEMS due to anti-VGCC antibodies subtype P/Q, who developed psychotic symptoms 3 years after the onset of motor symptoms. These symptoms decreased after every cycle of monthly intravenous immunoglobulin therapy. Different causes of reversible psychosis were excluded, such as autoimmune encephalitis. Due to a worsening of the patient's muscle strength, and the psychotic episodes, the patient received several treatments including an admission to a neurology unit. To our knowledge, this is the first described case of psychotic symptoms associated with LEMS. We speculate that VGCC antibodies could have a role in the development of mental symptoms, although additional hypotheses are also discussed.

Charles Bonnet syndrome (CBS) is a clinical condition in which patients with visual impairment experience visual hallucinations (VH) in the presence of clear consciousness. It typically occurs in elderly people and confuses clinicians with multiple differential diagnoses due to VH, which can be present in a variety of clinical conditions ranging from psychosis to neurocognitive disorders (eg, neurocognitive disorder with Lewy bodies). In the latter, the concomitant presence of cognitive decline and parkinsonism aids the diagnosis. Here we report the case of an elderly man with retinitis pigmentosa (and thus significant visual loss), who presented with VH, thus warranting a diagnosis of CBS, but who later also manifested a rapid onset cognitive decline and parkinsonism, which necessitated a new diagnosis of major neurocognitive disorder with Lewy bodies. This case prompted us to consider whether CBS is a harbinger of neurocognitive disorder with Lewy bodies or whether there is a clinical overlap between these 2 clinical constructs. This case report attempts to unravel this clinical conundrum.

Borderline personality disorder (BPD) poses significant challenges for early identification and diagnosis due to its intricate symptomatology that overlaps with other psychiatric illnesses. To address this challenge, the McLean Screening Instrument for BPD (MSI-BPD) was developed to identify individuals displaying potential BPD symptoms. This review aims to consolidate the current limited body of research on the MSI-BPD, delving into its origins, the rigor of its validation process, its practicality in clinical settings, and potential applications. By comprehensively examining these aspects, clinicians and researchers involved in BPD assessment and diagnosis can develop a deeper understanding of the instrument's utility. The MSI-BPD's development involved meticulous consideration of BPD diagnostic criteria, resulting in a tool tailored to effectively capture relevant symptoms. Validation studies have provided supportive evidence for its accuracy in identifying individuals at risk of BPD, thereby underlining its utility as a resource for early screening and intervention in clinical settings. However, it is essential to acknowledge that, while the MSI-BPD demonstrates satisfactory psychometric properties and utility as a screening tool for BPD, its diagnostic accuracy may vary across diverse populations. Consequently, clinicians and academics must judiciously consider sample characteristics and potential limitations when utilizing this instrument in both clinical and research contexts. Recognizing the advantages and potential applications of the MSI-BPD within a comprehensive approach to addressing BPD is important for professionals working in the field of BPD assessment and diagnosis. It is important to emphasize that the MSI-BPD is a screening tool and one data point in understanding patients presenting with complex symptomatology.

Insomnia, characterized by difficulty initiating or maintaining sleep, or poor sleep quality, is highly prevalent among individuals with substance use disorders (SUDs). The relationship between the 2 conditions is often bidirectional. We reviewed the impact of various substances (alcohol, stimulants, opioids, and cannabis) on sleep architecture and their potential to contribute to insomnia. The role of insomnia as a risk factor for different SUDs is also explored. Assessment strategies for co-occurring insomnia and SUDs are discussed, emphasizing the importance of reassessment throughout various phases of substance use treatment. Evidence-based nonpharmacologic and pharmacologic interventions for managing insomnia in SUD patients are presented, highlighting the importance of tailoring treatment approaches to individual needs and substance-specific considerations. Assessment and management of comorbid insomnia and SUDs is crucial but can be difficult; however, studies have shown some benefits using nonpharmacologic and pharmacologic approaches.

Objective: To examine trends and predictors of administrative actions against psychiatric clinicians' licenses between 2002 and 2022.

Methods: Data from the National Practitioner Data Bank (NPDB) identified 6400 disciplinary actions against psychiatric clinicians' licenses. Linear trend models assessed the trends of disciplinary actions across mental/physical health, licensing/legal issues, and unprofessional conduct. A first-order autoregressive model with a time indicator interaction term evaluated structural breaks (ie, a sudden or gradual change in the characteristics of data in a time series). Predictors of claims were assessed using logistic regression.

Results: Since 2002, disciplinary actions related to clinicians' mental/physical health (P=0.004) and licensure/legal issues (P=0.018) have decreased, while actions related to unprofessional conduct remained unchanged (P=0.358). Declines emerged in 2012 for mental/physical health (break coefficient -0.367; P=0.026) and in 2009 for unprofessional conduct (break coefficient -0.199; P=0.013). Clinicians facing disciplinary actions related to physical/mental health were significantly younger than those with legal/licensure issues (P<0.001). While the average age remained stable for mental/physical health-related actions, the average age increased for actions related to licensure/legal claims and unprofessional conduct.

Conclusions: The decrease in disciplinary actions related to physical/mental health may reflect better access and acceptance of treatment of clinicians, while the reduction in licensure/legal actions may indicate policy shifts. Findings regarding age underscore the need for enhanced support for mid and late-career clinicians to promote lifelong learning and practice.

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.

This article presents a case demonstrating that multiple medication use can begin on the first outpatient visit if the prescriber makes multiple psychiatric diagnoses and then feels the need to treat each diagnosis with a different central nervous system active medication labeled for each indication. This approach poses potential problems. First, a single drug or perhaps 2 drugs, in this case, may have been sufficient as initial and perhaps final treatment. Second, the prescriber cannot tell which drug(s) is/are producing either a beneficial or an adverse effect. This approach may stem from prescribers thinking that if they have made a diagnosis then they need to treat it with a drug labeled for or clinically used to treat that indication rather than taking a more conservative approach. However, such an approach adversely affects the ability to determine cause-and-effect relationships and hence adversely affects the ability to determine the best way to revise the treatment going forward.