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Recurrent hypothermia in elderly patient with Alzheimer's Dementia and Psychotic features with Risperidone therapy: A Rare Case Report. 利培酮治疗阿尔茨海默氏痴呆症和精神病特征老年患者的复发性低体温症:罕见病例报告。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-11-14 DOI: 10.1016/j.jaclp.2024.11.002
Shrinjay Vyas, Shubham Garg
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引用次数: 0
2024 ACLP Recommendations for Training Residents in Consultation-Liaison Psychiatry. 2024 ACLP 关于培训咨询联络精神病学住院医师的建议。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-11-10 DOI: 10.1016/j.jaclp.2024.11.001
Scott R Beach, Carrie L Ernst, David C Fipps, Thomas M Soeprono, Mallika Lavakumar, Samuel P Greenstein, Thomas W Heinrich, Ann C Schwartz

Introduction: Despite rapid shifts in consultation-liaison psychiatry (CLP) training in residency, including increasing general residency training requirements from the Accreditation Council for Graduate Medical Education, greater utilization of advanced practice providers, and effects of the coronavirus-2019 pandemic, the Academy of Consultation-Liaison Psychiatry (ACLP) has not updated recommendations for residency training in CLP since 2014. A national survey of residency program directors in 2021 suggested many changes to the structure of CLP rotations at individual programs over the past decade.

Methods: We convened a workgroup of 8 ACLP members holding leadership positions in residency and fellowship education on local and national levels. The project was approved by the ACLP Executive Council and conducted via a three-stage iterative process.

Results: Consensus was reached on 34 recommendations across four domains, including structural issues, faculty supervsion, formal curriculum and evaluations, and elective experiences.

Discussion: Residents must spend sufficient time on CLP rotations to achieve relevant milestones. Given that consultants are expected to offer unique insight, the ideal placement of core CLP rotations comes at a time in residency where residents are able to provide expert opinion and lead teams. Faculty expertise in CLP and availability to provide direct supervision and oversight to trainees is essential. A separate and formal CLP didactic curriculum should exist, and elective opportunities should be offered to supplement training.

Conclusions: These recommendations are intended to guide residency program directors towards optimizing CLP training for all residents, including those who will eventually pursue CLP fellowship. Establishing a strong CLP foundation for all residents is essential for ensuring competency in providing psychiatric care for medically complex patients and collaborating with our colleagues in other specialties, as well as fostering trainee interest in pursuing a career in CLP.

导言:尽管住院医师会诊联络精神病学(CLP)培训发生了快速变化,包括毕业后医学教育认证委员会对普通住院医师培训要求的提高、高级实践提供者的更多利用以及冠状病毒-2019大流行的影响,但自2014年以来,会诊联络精神病学学会(ACLP)一直没有更新CLP住院医师培训的建议。2021 年对住院医师培训项目主任进行的一项全国性调查显示,过去十年中,各个项目的 CLP 轮转结构发生了许多变化:我们召集了一个由8名在地方和国家层面的住院医师和研究员教育中担任领导职务的ACLP成员组成的工作组。该项目获得了ACLP执行委员会的批准,并通过三个阶段的迭代过程进行:结果:就四个领域的34项建议达成了共识,包括结构问题、教师监督、正式课程和评估以及选修经验:住院医师必须花足够的时间进行CLP轮转,以达到相关的里程碑。鉴于顾问应提供独到的见解,因此,在住院医师能够提供专家意见并领导团队时,才是安排核心 CLP 轮转的理想时机。教员必须具备 CLP 方面的专业知识,并能对受训者进行直接指导和监督。应开设单独和正式的 CLP 教学课程,并提供选修机会以补充培训:这些建议旨在指导住院医师培训项目主任优化所有住院医师的 CLP 培训,包括那些最终将获得 CLP 研究金的住院医师。为所有住院医师打下坚实的 CLP 基础,对于确保他们有能力为病情复杂的患者提供精神科护理、与其他专科的同事合作以及培养学员对从事 CLP 职业的兴趣至关重要。
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引用次数: 0
Metabolic and Endocrine Correlates of Subclinical Hypothyroidism in Young Adults with First-Episode and Drug-Naive Major Depressive Disorder. 首次发病和无药可治的重度抑郁症青年患者亚临床甲状腺机能减退的代谢和内分泌相关性。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-11-08 DOI: 10.1016/j.jaclp.2024.10.003
ZhaoXuan Shang, ChunQing Fang, XiaoE Lang, Xiangyang Zhang

Background: Major Depressive Disorder (MDD) is often associated with Subclinical Hypothyroidism (SCH), but the clinical and biochemical characteristics in young, first-episode, drug-naive patients remain unclear. This study aims to examine the prevalence and clinical correlates of SCH in this population to enhance screening and management strategies.

Method: A cross-sectional study included 917 young Chinese patients (aged 18-35) diagnosed with first-episode, drug-naive MDD. Comprehensive clinical assessments were conducted, involving demographic data, psychiatric evaluations using the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS), alongside biochemical measurements such as thyroid stimulating hormone, thyroid peroxidase antibodies (TPOAb), fasting blood glucose (FBG), total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Binary logistic regression identified clinical correlates of SCH.

Results: The prevalence of SCH among the study population was 58%. Logistic regression analysis identified significant predictors of SCH, including higher HAMD scores (OR = 1.26), TPOAb (OR = 1.003), FBG (OR = 2.28), TC (OR = 1.66), SBP (OR = 1.11), and DBP (OR = 1.07). In contrast, lower HDLC levels (OR = 0.28) were inversely associated with SCH.

Conclusion: The high prevalence of SCH in young, first-episode, drug-naive MDD patients emphasizes the need for comprehensive metabolic and endocrine evaluations. Regular monitoring of thyroid function, glucose levels, blood pressure, and lipid profiles is crucial for early detection and intervention, potentially improving clinical outcomes in this vulnerable group.

背景:重度抑郁障碍(MDD)通常与亚临床甲状腺功能减退症(SCH)有关,但首次发病、未服药的年轻患者的临床和生化特征仍不清楚。本研究旨在探讨SCH在这一人群中的患病率和临床相关性,以加强筛查和管理策略:一项横断面研究纳入了917名被诊断为首次发病、对药物无效的MDD中国年轻患者(18-35岁)。研究人员对这些患者进行了全面的临床评估,包括人口统计学数据、使用汉密尔顿抑郁评定量表(HAMD)、汉密尔顿焦虑评定量表(HAMA)和阳性与阴性综合征量表(PANSS)进行的精神评估,以及生化指标(如促甲状腺激素、甲状腺过氧化物酶抗体和甲状腺激素)、甲状腺过氧化物酶抗体 (TPOAb)、空腹血糖 (FBG)、总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDLC)、低密度脂蛋白胆固醇 (LDLC)、收缩压 (SBP) 和舒张压 (DBP)。二元逻辑回归确定了 SCH 的临床相关因素:结果:研究人群中 SCH 的患病率为 58%。逻辑回归分析确定了SCH的重要预测因素,包括较高的HAMD评分(OR = 1.26)、TPOAb(OR = 1.003)、FBG(OR = 2.28)、TC(OR = 1.66)、SBP(OR = 1.11)和DBP(OR = 1.07)。相反,较低的 HDLC 水平(OR = 0.28)与 SCH 成反比:结论:SCH在年轻、首次发病、对药物无效的MDD患者中的高发病率强调了对代谢和内分泌进行全面评估的必要性。定期监测甲状腺功能、血糖水平、血压和血脂情况对早期发现和干预至关重要,有可能改善这一弱势群体的临床预后。
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引用次数: 0
Preoperative neurofilament light associated with postoperative delirium in hip fracture repair patients without dementia. 术前神经丝光与无痴呆症的髋部骨折修复患者术后谵妄有关。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-11-08 DOI: 10.1016/j.jaclp.2024.10.002
Mfon Umoh, Haijuan Yan, Jeannie-Marie Leoutsakos, Alexandria Lewis, Edward R Marcantonio, Constantine G Lyketsos, Sharon K Inouye, Abhay Moghekar, Karin J Neufeld, Paul B Rosenberg, Frederick Sieber, Esther S Oh

Background: Delirium commonly occurs in older adults following surgery; although its pathophysiology is not fully understood, underlying neurodegeneration is a risk factor.

Objective: Examine the association of preoperative levels of markers of neuronal damage, neurofilament light (NfL) and phosphorylated tau (p-tau)181, with postoperative delirium.

Methods: Preoperative CSF and plasma were obtained from 158 patients undergoing hip fracture repair and enrolled in the clinical trial "A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients" (STRIDE). Delirium diagnosis was adjudicated by a consensus panel. The association of plasma and CSF NfL and p-tau181 levels with delirium incidence and severity were examined for the overall cohort and for the subgroup (n=134) of patients without dementia.

Results: Patients who developed delirium were older, had lower Mini-Mental State Exam (MMSE) score, higher Clinical Dementia Rating (CDR) and Geriatric Depression Scale (GDS) scores at baseline; the overall incidence of delirium was 37.6% and 31.1% for the subgroup without dementia. Plasma and CSF p-tau181 levels were not associated with delirium incidence or severity. CSF NfL levels were significantly associated with delirium severity, but not with incidence in the overall cohort. In the subgroup of patients without dementia, CSF NfL levels were significantly associated with increased odds of delirium incidence (OR 4.74, 95% CI 1.21-18.59, p=0.03) adjusted for age, sex, and CDR.

Conclusions: CSF NfL was significantly associated with delirium incidence and severity in patients without dementia undergoing hip fracture repair. Results confirm prior studies suggesting NfL as an important marker of delirium risk and supports an association between pre-existing axonal injury and delirium. These results highlight delirium vulnerability in older hip fracture patients, even when clinical dementia is not identified.

背景:谵妄通常发生在手术后的老年人身上;虽然其病理生理学尚未完全清楚,但潜在的神经变性是一个风险因素:谵妄通常发生在手术后的老年人身上;尽管其病理生理学尚不完全清楚,但潜在的神经变性是一个风险因素:目的:研究术前神经元损伤标志物神经丝光(NfL)和磷酸化 tau(p-tau)181 的水平与术后谵妄的关系:方法:从 158 名接受髋部骨折修补术并加入 "降低老年患者术后谵妄发生率的策略"(STRIDE)临床试验的患者中获取术前 CSF 和血浆。谵妄诊断由共识小组裁定。对整个队列和无痴呆患者亚组(n=134)的血浆和脑脊液NfL和p-tau181水平与谵妄发生率和严重程度的关系进行了研究:出现谵妄的患者年龄较大,迷你精神状态检查(MMSE)评分较低,基线时临床痴呆评分(CDR)和老年抑郁量表(GDS)评分较高;谵妄的总体发生率为37.6%,无痴呆亚组的发生率为31.1%。血浆和脑脊液p-tau181水平与谵妄发生率或严重程度无关。CSF中的NfL水平与谵妄严重程度显著相关,但与整个队列中的谵妄发生率无关。在无痴呆症患者亚组中,CSF NfL水平与谵妄发生率的增加显著相关(OR 4.74,95% CI 1.21-18.59,p=0.03),已对年龄、性别和CDR进行调整:在接受髋部骨折修补术的无痴呆患者中,CSF NfL与谵妄的发生率和严重程度密切相关。研究结果证实了之前的研究提示NfL是谵妄风险的重要标志物,并支持已有的轴突损伤与谵妄之间存在关联。这些结果凸显了老年髋部骨折患者的谵妄易感性,即使在未发现临床痴呆的情况下也是如此。
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引用次数: 0
Zolpidem for the Management of Catatonia: A Systematic Review. 唑吡坦用于治疗卡他性精神障碍:系统综述。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-11-08 DOI: 10.1016/j.jaclp.2024.10.004
Matthew Gunther, Nathan Tran, Shixie Jiang

Background: Catatonia is a psychomotor syndrome associated with neurotransmitter disturbances, common in both psychiatric and medical settings. Hypoactivity of the GABAA receptor is one of the predominant theories behind the pathophysiology of catatonia, affecting both motor functioning and emotional regulation. Benzodiazepines such as lorazepam are considered the first-line treatment for catatonia. However, up to 27% of catatonia cases fail to respond to benzodiazepines alone. Zolpidem, which can be used as a challenge, monotherapy, or augmentation agent, serves as a promising pharmacological agent for catatonia due to its unique pharmacodynamic and pharmacokinetic profile.

Objective: We sought to systematically examine the evidence behind zolpidem's use among adult patients to understand its clinical utility in the management of catatonia against prevailing treatments such as lorazepam and electroconvulsive therapy (ECT).

Methods: We conducted a systematic review using search terms related to zolpidem and catatonia in PubMed, EMBASE, and Web of Science. We followed PRISMA guidelines and identified 29 studies, including case studies and case series, that met inclusion criteria.

Results: We reviewed 35 cases in which zolpidem was used for catatonia management (age: M =51.5 ± 21.0 SD years; 68.6% female; Bush Francis Catatonia Rating Scale: M=22.2 ± 9.0 SD). Proportions of positive responses for zolpidem on catatonia varied by treatment approach: 91% as a challenge agent (n=10), 100% as a first-line monotherapy agent (n=3), 57% as a first-line combination therapy agent (n=4), 70% as a second-line monotherapy agent (n=7), and 100% as a second-line augmentation agent (n=4). In total, 28 out of the 35 reported cases of catatonia (80%) responded positively to zolpidem.

Conclusions: An 80% positive response rate for zolpidem in lysing catatonia is encouraging but may be an overestimate due to reporting bias of case level data. Results may be explained by zolpidem's selectivity for the α1 subunit of the GABAA receptor. Thus, zolpidem may be an under-utilized catatonia treatment and prove useful in situations when benzodiazepines fail or when ECT access is limited. Given that current literature on the use of zolpidem for catatonia is limited to case reports, more robust research in this area is warranted.

背景:紧张症是一种与神经递质紊乱有关的精神运动综合征,在精神病和医疗环境中都很常见。GABAA 受体功能减退是紧张症病理生理学的主要理论之一,它会影响运动功能和情绪调节。劳拉西泮等苯二氮卓类药物被认为是紧张症的一线治疗药物。然而,高达 27% 的紧张性精神障碍患者对苯二氮卓类药物无效。唑吡坦可作为挑战药、单药或增效药使用,由于其独特的药效学和药代动力学特征,唑吡坦有望成为治疗紧张性精神障碍的一种药理药剂:我们试图系统研究唑吡坦在成年患者中使用的证据,以了解其在治疗紧张症方面的临床效用,并与劳拉西泮和电休克疗法(ECT)等主流疗法进行对比:我们使用 PubMed、EMBASE 和 Web of Science 中与唑吡坦和紧张症相关的检索词进行了系统性综述。我们遵循 PRISMA 指南,确定了 29 项符合纳入标准的研究,包括病例研究和系列病例:我们回顾了 35 例使用唑吡坦治疗紧张症的病例(年龄:男 =51.5 ± 21.0 SD 岁;68.6% 为女性;布什-弗朗西斯紧张症评定量表:男 =22.2 ± 9.0 SD 岁;68.6% 为女性):M=22.2±9.0SD)。唑吡坦对紧张症的阳性反应比例因治疗方法而异:91%作为挑战药物(10 人),100%作为一线单药治疗药物(3 人),57%作为一线联合治疗药物(4 人),70%作为二线单药治疗药物(7 人),100%作为二线增强药物(4 人)。在报告的35例紧张性精神分裂症病例中,共有28例(80%)对唑吡坦有阳性反应:结论:唑吡坦对失张力症的阳性反应率为 80%,这一结果令人鼓舞,但由于病例数据的报告偏差,这一结果可能被高估了。唑吡坦对 GABAA 受体的 α1 亚基具有选择性,这或许可以解释这一结果。因此,唑吡坦可能是一种未被充分利用的紧张症治疗方法,在苯二氮卓类药物失效或电痉挛疗法使用受限的情况下,唑吡坦可能会被证明是有用的。鉴于目前关于使用唑吡坦治疗紧张症的文献仅限于病例报告,因此有必要在这一领域开展更深入的研究。
{"title":"Zolpidem for the Management of Catatonia: A Systematic Review.","authors":"Matthew Gunther, Nathan Tran, Shixie Jiang","doi":"10.1016/j.jaclp.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.jaclp.2024.10.004","url":null,"abstract":"<p><strong>Background: </strong>Catatonia is a psychomotor syndrome associated with neurotransmitter disturbances, common in both psychiatric and medical settings. Hypoactivity of the GABA<sub>A</sub> receptor is one of the predominant theories behind the pathophysiology of catatonia, affecting both motor functioning and emotional regulation. Benzodiazepines such as lorazepam are considered the first-line treatment for catatonia. However, up to 27% of catatonia cases fail to respond to benzodiazepines alone. Zolpidem, which can be used as a challenge, monotherapy, or augmentation agent, serves as a promising pharmacological agent for catatonia due to its unique pharmacodynamic and pharmacokinetic profile.</p><p><strong>Objective: </strong>We sought to systematically examine the evidence behind zolpidem's use among adult patients to understand its clinical utility in the management of catatonia against prevailing treatments such as lorazepam and electroconvulsive therapy (ECT).</p><p><strong>Methods: </strong>We conducted a systematic review using search terms related to zolpidem and catatonia in PubMed, EMBASE, and Web of Science. We followed PRISMA guidelines and identified 29 studies, including case studies and case series, that met inclusion criteria.</p><p><strong>Results: </strong>We reviewed 35 cases in which zolpidem was used for catatonia management (age: M =51.5 ± 21.0 SD years; 68.6% female; Bush Francis Catatonia Rating Scale: M=22.2 ± 9.0 SD). Proportions of positive responses for zolpidem on catatonia varied by treatment approach: 91% as a challenge agent (n=10), 100% as a first-line monotherapy agent (n=3), 57% as a first-line combination therapy agent (n=4), 70% as a second-line monotherapy agent (n=7), and 100% as a second-line augmentation agent (n=4). In total, 28 out of the 35 reported cases of catatonia (80%) responded positively to zolpidem.</p><p><strong>Conclusions: </strong>An 80% positive response rate for zolpidem in lysing catatonia is encouraging but may be an overestimate due to reporting bias of case level data. Results may be explained by zolpidem's selectivity for the α<sub>1</sub> subunit of the GABA<sub>A</sub> receptor. Thus, zolpidem may be an under-utilized catatonia treatment and prove useful in situations when benzodiazepines fail or when ECT access is limited. Given that current literature on the use of zolpidem for catatonia is limited to case reports, more robust research in this area is warranted.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acute Onset or Worsening of Psychiatric Symptoms Following Breastfeeding Cessation: An Illustrative Case and Literature Review. 停止母乳喂养后精神症状的急性发作或恶化:例证与文献综述。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-10-19 DOI: 10.1016/j.jaclp.2024.10.001
Katherine A Meidl, Bailey N Brooks, Stacey A Pawlak, Melissa B Ludgate

Background: Breastfeeding shares a complex, occasionally contradictory relationship with maternal mental health. Both positive and negative mood impacts have been noted in relation to breastfeeding initiation as well as cessation. Though popular magazines and online forums discuss the onset of psychiatric symptoms following weaning, there is limited medical literature detailing this relationship.

Objective: To increase awareness regarding psychiatric symptom development in the context of breastfeeding cessation.

Methods: We describe the case of a patient who developed psychiatric symptoms shortly after weaning, including acute-onset insomnia and worsening anxiety. A literature review of psychiatric symptom development following breastfeeding cessation was conducted using the search engines PubMed, PsycINFO (EBSCOhost), and Embase. Search terms included controlled vocabulary, keywords (within title and abstract fields), synonyms, and related concepts for postpartum period, postpartum depression, postpartum anxiety, breastfeeding cessation, breastfeeding weaning, lactation, dysphoric milk ejection reflex, and insomnia. Relevant case reports were reviewed and compared to this case. Information including the patient's age, psychiatric symptoms, past psychiatric history, medical workup, treatment, and outcome was extracted from each article.

Results: Nine patients who developed psychiatric symptoms following breastfeeding cessation were identified in six case reports. Three patients experienced recurrent symptoms in multiple pregnancies. This led to documentation of 13 discrete postweaning syndromes. All cases involved either first-time parents, those new to breastfeeding, or those experiencing symptoms during multiple weaning periods. Synthesizes data from the article review. As with our case, 11 clinical cases describe sleep changes (primarily insomnia) and 4 discuss anxiety symptoms. Treatment varied based upon symptoms experienced, with no consistently effective treatments identified across cases.

Conclusions: This case of unspecified insomnia and anxiety disorders following abrupt weaning adds to the limited literature in the field and suggests that physiologic and psychologic factors associated with breastfeeding cessation may play a role in the development or worsening of postpartum mood disorders. Intensive psychiatric treatment resulted in resolution of the patient's symptoms. The relationship between weaning and psychiatric disorders is evident in the lay press but is underrepresented in medical literature. Additional research is needed to better understand this relationship so that physicians can counsel, diagnose, and treat patients more effectively.

背景:母乳喂养与产妇的心理健康有着复杂的关系,有时甚至是相互矛盾的。人们注意到,母乳喂养的开始和停止都会对情绪产生积极和消极的影响。尽管流行杂志和在线论坛讨论了断奶后精神症状的出现,但详细阐述这种关系的医学文献却很有限:我们描述了一例断奶后不久即出现精神症状的患者,包括急性失眠和焦虑加重。我们使用 PubMed、PsycINFO (EBSCOhost) 和 Embase 等搜索引擎对停止母乳喂养后出现精神症状的文献进行了综述。检索词包括控制词汇、关键词(在标题和摘要字段内)、同义词和相关概念:产后时期、产后抑郁、产后焦虑、停止母乳喂养、断母乳喂养、泌乳、排乳反射障碍和失眠。我们查阅了相关病例报告,并与本病例进行了比较。从每篇文章中提取了包括患者年龄、精神症状、既往精神病史、医学检查、治疗和结果在内的信息:结果:在六篇病例报告中发现了九名在停止母乳喂养后出现精神症状的患者。其中有三位患者在多次妊娠中反复出现症状。由此记录了 13 种不同的断奶后综合征。所有病例均涉及初次为人父母者、刚开始母乳喂养者或在多次断奶期间出现症状者。表 1 综合了文章综述中的数据。与我们的病例一样,11 个临床病例描述了睡眠变化(主要是失眠),4 个病例讨论了焦虑症状。根据症状的不同,治疗方法也不尽相同,在不同病例中没有发现一致有效的治疗方法:本病例在突然断奶后出现不明原因的失眠和焦虑症,为该领域有限的文献资料增添了新的内容,并表明与停止母乳喂养相关的生理和心理因素可能在产后情绪障碍的发展或恶化中起作用。强化精神治疗后,患者的症状得到了缓解。断奶与精神障碍之间的关系在非专业媒体中很明显,但在医学文献中却很少见。需要进行更多的研究来更好地了解这种关系,以便医生能更有效地为患者提供咨询、诊断和治疗。
{"title":"Acute Onset or Worsening of Psychiatric Symptoms Following Breastfeeding Cessation: An Illustrative Case and Literature Review.","authors":"Katherine A Meidl, Bailey N Brooks, Stacey A Pawlak, Melissa B Ludgate","doi":"10.1016/j.jaclp.2024.10.001","DOIUrl":"10.1016/j.jaclp.2024.10.001","url":null,"abstract":"<p><strong>Background: </strong>Breastfeeding shares a complex, occasionally contradictory relationship with maternal mental health. Both positive and negative mood impacts have been noted in relation to breastfeeding initiation as well as cessation. Though popular magazines and online forums discuss the onset of psychiatric symptoms following weaning, there is limited medical literature detailing this relationship.</p><p><strong>Objective: </strong>To increase awareness regarding psychiatric symptom development in the context of breastfeeding cessation.</p><p><strong>Methods: </strong>We describe the case of a patient who developed psychiatric symptoms shortly after weaning, including acute-onset insomnia and worsening anxiety. A literature review of psychiatric symptom development following breastfeeding cessation was conducted using the search engines PubMed, PsycINFO (EBSCOhost), and Embase. Search terms included controlled vocabulary, keywords (within title and abstract fields), synonyms, and related concepts for postpartum period, postpartum depression, postpartum anxiety, breastfeeding cessation, breastfeeding weaning, lactation, dysphoric milk ejection reflex, and insomnia. Relevant case reports were reviewed and compared to this case. Information including the patient's age, psychiatric symptoms, past psychiatric history, medical workup, treatment, and outcome was extracted from each article.</p><p><strong>Results: </strong>Nine patients who developed psychiatric symptoms following breastfeeding cessation were identified in six case reports. Three patients experienced recurrent symptoms in multiple pregnancies. This led to documentation of 13 discrete postweaning syndromes. All cases involved either first-time parents, those new to breastfeeding, or those experiencing symptoms during multiple weaning periods. Synthesizes data from the article review. As with our case, 11 clinical cases describe sleep changes (primarily insomnia) and 4 discuss anxiety symptoms. Treatment varied based upon symptoms experienced, with no consistently effective treatments identified across cases.</p><p><strong>Conclusions: </strong>This case of unspecified insomnia and anxiety disorders following abrupt weaning adds to the limited literature in the field and suggests that physiologic and psychologic factors associated with breastfeeding cessation may play a role in the development or worsening of postpartum mood disorders. Intensive psychiatric treatment resulted in resolution of the patient's symptoms. The relationship between weaning and psychiatric disorders is evident in the lay press but is underrepresented in medical literature. Additional research is needed to better understand this relationship so that physicians can counsel, diagnose, and treat patients more effectively.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reversible Lithium-induced Bradycardia in a Patient With Wolff-Parkinson-White Syndrome. 一名沃尔夫-帕金森-怀特综合征患者因锂引起的可逆性心动过缓。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-10-10 DOI: 10.1016/j.jaclp.2024.09.007
Kristen Dzeda, Yang Liu, Rocksheng Zhong
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引用次数: 0
Nonprescribed Substance Use in the General Hospital: A Retrospective Study. 综合医院的非处方药物使用情况:一项回顾性研究。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-10-05 DOI: 10.1016/j.jaclp.2024.09.006
Lee M Dockery, Kristopher A Kast, Mariah Smith, Lisa S Stewart, Thomas Reese, Andrew D Wiese, Mauli V Shah, David E Marcovitz

Background: Nonprescribed substance use (NPSU) is a recognized phenomenon exhibited by patients with substance use disorders while admitted to inpatient hospitals. What factors distinguish patients who engage in NPSU, or how their hospitalizations and outcomes differ, remains to be understood in full.

Objectives: Our study describes a cohort of medically admitted patients with substance use disorders with behaviors concerning for NPSU during their hospitalization.

Methods: We extracted electronic health record data for all hospital encounters when an addiction consult was documented (n = 3100). We defined NPSU cases during a clinical, interdisciplinary case review in which patients were deemed high risk based on team members' observations of one or more behaviors described in the NPSU Checklist. These individuals were placed on a "NPSU Protocol," which was implemented for optimization of care, destigmatization, and risk mitigation (n = 61). We compared clinical characteristics, resource utilization, and treatment outcomes among the NPSU cohort to addiction consult patients without suspicion of NPSU but with stimulant or opioid use disorder diagnoses.

Results: Patients on the NPSU protocol were younger and had higher rates of infectious disease diagnoses reported during hospitalization than patients without concern for NPSU. Hospitalizations for individuals suspected of NPSU were longer, had higher rates of before medically advised discharge, as well as discharges without medications for opioid use disorder. These outcome differences were also observed when analysis was restricted to hospitalizations in which an infectious disease was diagnosed.

Conclusions: Our study characterizes a population of people who exhibited behaviors concerning for NPSU and highlights key outcome disparities. To our knowledge, this study is the first to show a direct correlation between infectious disease diagnosis and NPSU, as well as a direct correlation between suspected NPSU and outcomes such as before medically advised discharge and discharge without medications for opioid use disorder, irrespective of infectious disease diagnosis. Further study is necessary to determine interventions to reduce poor outcomes among hospitalized patients with NPSU.

背景和目的:非处方药物使用(NPSU)是公认的药物使用障碍患者在住院期间表现出的一种现象。非处方药物使用患者的区别因素是什么,他们的住院情况和治疗结果有何不同,这些问题仍有待全面了解。我们的研究描述了一组在住院期间有非处方药物使用(NPSU)行为的药物使用障碍住院患者:我们提取了有成瘾咨询记录的所有住院病例的电子健康记录数据(n=3100)。我们在临床跨学科病例审查期间定义了 NPSU 病例,根据小组成员对 NPSU 检查表中描述的一种或多种行为的观察,患者被视为高风险患者。这些患者被纳入 "NPSU 协议",以优化护理、消除耻辱感和降低风险(n=61)。我们将 NPSU 群组的临床特征、资源利用率和治疗结果与未怀疑 NPSU 但诊断为兴奋剂或阿片类药物使用障碍的成瘾咨询患者进行了比较:与未被怀疑患有非典型肺炎的患者相比,接受非典型肺炎治疗方案的患者更年轻,住院期间报告的传染病诊断率更高。疑似 NPSU 患者的住院时间更长,在医疗建议出院前出院的比例更高,且出院时未服用阿片类药物使用障碍 (MOUD) 药物。当分析仅限于确诊为传染病的住院患者时,也观察到了这些结果差异:我们的研究描述了表现出非典型肺炎相关行为的人群的特征,并强调了主要的结果差异。据我们所知,这项研究首次显示了传染病诊断与 NPSU 之间的直接相关性,以及疑似 NPSU 与医疗建议出院前和无 MOUD 出院等结果之间的直接相关性,无论传染病诊断与否。有必要开展进一步研究,以确定减少 NPSU 住院患者不良预后的干预措施。
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引用次数: 0
First Suicide Attempts in Early Adolescents: A Descriptive Outcomes Study. 青少年首次自杀未遂:一项描述性结果研究。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-10-05 DOI: 10.1016/j.jaclp.2024.09.003
Alastair J McKean, Chaitanya Pabbati, Tanner J Bommersbach, Jennifer R Geske, J Michael Bostwick

Background: In 2021, suicide was the second leading cause of death in early adolescent Americans ages 10-14. Research into suicidal behavior in this age group is limited. We report on prior psychiatric care, attempt method, and attempt outcomes in a cohort of 164 early adolescents accrued by first suicide attempt coming to medical attention.

Methods: Our cohort constitutes a subsample from a previously reported retrospective-prospective study identified through the Rochester Epidemiology Project that recruited individuals making first suicide attempts coming to medical attention (index attempt [IA]) during a 22-year period (1/1/1986-31/12/07). Among 1490 all-age index attempters followed until 12/31/2010, 164 (11.0%) were aged 10-14.

Results: 3/164 died on IA (1.8% of the cohort; two females, one male). Nearly half (72/164, 43.9%) had no prior psychiatric history. Females were less likely than males to have seen a mental health provider (P = 0.029) or been prescribed psychiatric medications (P < 0.001) prior to IA. Medication overdose was the most common attempt method in females (81/128, 63.3%), while cutting or piercing wounds were the most common method in males (13/36, 36.1%). Females were significantly more likely than males to overdose (P = 0.001). Of IA survivors, 19.9% (32/161) were initially medically hospitalized, 52.8% (85/161) were psychiatrically hospitalized-initially or in transfer-and 37.2% (60/161) were discharged without hospitalization.

Conclusion: Medication overdoses accounted for over half of all IAs and were significantly more common in females. While IA mortality was low relative to older patients from the all-age-cohort, morbidity was substantial with nearly a fifth of attempts severe enough to warrant medical hospitalization and more than half initial or eventual psychiatric hospitalization. These findings emphasize the importance of both means restriction and identification of early adolescents at risk before they make their first attempt.

目标:2021 年,自杀是导致 10-14 岁美国青少年死亡的第二大原因。对这一年龄组自杀行为的研究十分有限。我们报告了一个由 164 名青少年组成的队列中之前的精神科治疗、自杀尝试方法和自杀尝试结果,该队列由首次自杀未遂并就医的青少年组成:我们的队列是从之前报道的罗切斯特流行病学项目(Rochester Epidemiology Project)所确定的回顾性-前瞻性研究中的一个子样本,该项目招募了在 22 年内(1986 年 1 月 1 日至 2007 年 12 月 31 日)首次企图自杀并就医的人(指数企图,IA)。在追踪至 2010 年 12 月 31 日的 1490 名全年龄段自杀未遂者中,164 人(11.0%)的年龄在 10-14 岁之间:3/164人死于自杀未遂(占队列的1.8%;2名女性,1名男性)。近一半的患者(72/164,43.9%)之前没有精神病史。女性比男性更不可能看过心理健康提供者(P=0.029)或开过精神科处方药(P结论:女性比男性更不可能看过心理健康提供者(P=0.029)或开过精神科处方药(P=0.029):用药过量占所有内科病例的一半以上,而且在女性中更为常见。虽然与全年龄组的老年患者相比,药物滥用的死亡率较低,但发病率却很高,近五分之一的药物滥用严重到需要住院治疗,一半以上的药物滥用患者最初或最终被送入精神病院。这些研究结果表明,在青少年首次尝试自杀之前,对他们进行手段限制和识别高危青少年非常重要。
{"title":"First Suicide Attempts in Early Adolescents: A Descriptive Outcomes Study.","authors":"Alastair J McKean, Chaitanya Pabbati, Tanner J Bommersbach, Jennifer R Geske, J Michael Bostwick","doi":"10.1016/j.jaclp.2024.09.003","DOIUrl":"10.1016/j.jaclp.2024.09.003","url":null,"abstract":"<p><strong>Background: </strong>In 2021, suicide was the second leading cause of death in early adolescent Americans ages 10-14. Research into suicidal behavior in this age group is limited. We report on prior psychiatric care, attempt method, and attempt outcomes in a cohort of 164 early adolescents accrued by first suicide attempt coming to medical attention.</p><p><strong>Methods: </strong>Our cohort constitutes a subsample from a previously reported retrospective-prospective study identified through the Rochester Epidemiology Project that recruited individuals making first suicide attempts coming to medical attention (index attempt [IA]) during a 22-year period (1/1/1986-31/12/07). Among 1490 all-age index attempters followed until 12/31/2010, 164 (11.0%) were aged 10-14.</p><p><strong>Results: </strong>3/164 died on IA (1.8% of the cohort; two females, one male). Nearly half (72/164, 43.9%) had no prior psychiatric history. Females were less likely than males to have seen a mental health provider (P = 0.029) or been prescribed psychiatric medications (P < 0.001) prior to IA. Medication overdose was the most common attempt method in females (81/128, 63.3%), while cutting or piercing wounds were the most common method in males (13/36, 36.1%). Females were significantly more likely than males to overdose (P = 0.001). Of IA survivors, 19.9% (32/161) were initially medically hospitalized, 52.8% (85/161) were psychiatrically hospitalized-initially or in transfer-and 37.2% (60/161) were discharged without hospitalization.</p><p><strong>Conclusion: </strong>Medication overdoses accounted for over half of all IAs and were significantly more common in females. While IA mortality was low relative to older patients from the all-age-cohort, morbidity was substantial with nearly a fifth of attempts severe enough to warrant medical hospitalization and more than half initial or eventual psychiatric hospitalization. These findings emphasize the importance of both means restriction and identification of early adolescents at risk before they make their first attempt.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medical Psychiatry Units: A Delphi Consensus Approach to Defining Essential Characteristics. 内科精神科病房:采用德尔菲共识法确定基本特征。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2024-10-05 DOI: 10.1016/j.jaclp.2024.09.004
Susan L Padrino, Aubrey C Chan, Maarten van Schijndel, Marsha N Wittink

Medical psychiatry units (MPUs), also known as complexity intervention units, represent an important innovation for integrating medical and behavioral health care in the hospital setting, thereby reducing the need for sequential medical and psychiatric hospitalization. As US hospitals face an increased demand for mental health services, interest in the MPU model is gaining momentum. However, there is no shared definition for what constitutes an MPU, and significant variation exists among units across the United States that have been designated as an MPU. The lack of a unified definition for MPUs results in significant variability and poses challenges for creating new MPUs and studying existing MPUs. To address this gap, the Medical-Psychiatry Unit Consortium recruited a panel of MPU experts to conduct a consensus study. The consortium used a survey to assess the relative importance of various characteristics of MPUs within the following categories: structural organization, environment and design, spectrum of care, staffing, and culture of care. After two rounds of a modified Delphi process, consensus was achieved with regard to which characteristics are necessary or preferred vs. not necessary or harmful. The necessary or preferred characteristics include those that would be expected on a general medical unit, such as having cardiac telemetry monitoring capabilities, as well as characteristics typical of a psychiatric unit, such as locked unit doors, locked cabinets for patient belongings, and common area or milieu. Overall, this suggests that an ideal MPU combines the ability to provide acute medical care with acute psychiatric care. Notably, staffing and culture of care emerged as categories with the highest ranking of necessary characteristics, outweighing environment, design, or the breadth of services offered. These findings suggest that MPU experts feel teamwork and having a shared mission are critical components of effective MPUs and highlight the importance of staff recruitment and training.

精神科医疗单元(MPUs),又称复杂性干预单元,是在医院环境中整合医疗和行为保健的一项重要创新,从而减少了医疗和精神科连续住院的需求。随着美国医院对心理健康服务的需求不断增加,人们对 MPU 模式的兴趣也日益高涨。然而,对于什么是 MPU 并没有一个共同的定义,美国各地被指定为 MPU 的单位之间也存在着很大的差异。缺乏对 MPU 的统一定义导致了巨大的差异,为创建新的 MPU 和研究现有 MPU 带来了挑战。为了填补这一空白,医疗-精神病学单位联盟招募了一个由多学科综合单位专家组成的小组来开展一项共识研究。联合会通过一项调查来评估多学科综合病房在以下类别中各种特征的相对重要性:结构组织、环境和设计、护理范围、人员配备和护理文化。经过两轮修改后的德尔菲程序,就哪些特征是必要的或首选的,哪些特征是不必要的或有害的达成了共识。必要或首选的特征包括普通医疗单元应有的特征,如具备心电遥测监控功能,以及精神科单元的典型特征,如单元门上锁、病人物品柜上锁、公共区域或环境上锁。总体而言,这表明理想的重症监护病房应兼具提供急症医疗护理和急症精神病护理的能力。值得注意的是,人员配备和护理文化是必要特征中排名最高的类别,超过了环境、设计或所提供服务的广度。这些研究结果表明,多学科综合病房专家认为团队合作和共同的使命是有效的多学科综合病房的重要组成部分,并强调了人员招聘和培训的重要性。
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引用次数: 0
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Journal of the Academy of Consultation-Liaison Psychiatry
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