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Treating to Capacity: A Case of Mesenteric Ischemia Complicated by Psychotic Depression.
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-23 DOI: 10.1016/j.jaclp.2025.01.003
Arjun Mann, Flannery Merideth
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引用次数: 0
Recognizing Withdrawal From Psychoactive Substances Purchased Online. 识别从网上购买的精神活性物质撤回。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-09 DOI: 10.1016/j.jaclp.2025.01.002
Cecilia N Hollenhorst, Brent Schnipke
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引用次数: 0
Successful Use of the Cultural Formulation Interview for Assessment and Management of a Migrant Patient With Anorexia Nervosa. 成功运用文化定式访谈法评估和管理一名流动神经性厌食症患者。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-09 DOI: 10.1016/j.jaclp.2025.01.001
Christine Huynh, Nana Park, Nia Harris, Diana Punko
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引用次数: 0
Clinical Utility and Performance of the Traditional Chinese Version of the 4-As Test for Delirium due to Traumatic Brain Injury.
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-04 DOI: 10.1016/j.jaclp.2024.12.005
Yun-Hsuan Lai, Chia-Jou Lin, I-Chang Su, Sheng-Wen Huang, Chia-Chi Hsiao, Ying-Ling Jao, Pin-Yuan Chen, Victoria Traynor, Chuan-Ya Lee, Ting-Jhen Chen, Mu-Hsing Ho, Hsiao-Yean Chiu

Background: Delirium is a common symptom following a traumatic brain injury that is often overlooked by healthcare professionals. Early detection of posttraumatic delirium is crucial to improving patient outcomes and quality of life. The 4 As Test (4AT: alertness, attention, abbreviated mental test-4, and acute mental changes) is a brief and rapid tool for delirium assessment with acceptable reliability and validity. However, the 4AT has not yet been translated for use in the Taiwanese population.

Objective: To translate the 4AT into Traditional Chinese (TC-4AT), assess its reliability and validity, and explore the clinical effects of delirium in patients with a traumatic brain injury.

Methods: This prospective observational study was conducted at the neurosurgery wards of 2 Taiwanese hospitals. Patients who were aged 20 years or older, were diagnosed with a traumatic brain injury, and had a Glasgow Coma Scale score between 13 and 15 were included. Interrater reliability was assessed, and validity was verified using criterion-related comparisons with the Short Confusion Assessment Method. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were employed to assess the sensitivity and specificity of the TC-4AT for screening posttraumatic brain injury delirium.

Results: A total of 100 patients with an average age of 67 years were enrolled, of whom 10% were diagnosed with delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The interrater reliability of the TC-4AT was 1.00. Patients with delirium tended to have a longer hospital stay than those without delirium (13 days vs. 7 days) although the difference was nonsignificant (P = 0.28). In terms of criterion validity, patients diagnosed with delirium using the Short Confusion Assessment Method had a significantly higher score on the TC-4AT than those not diagnosed with delirium (P < 0.001). The receiver operating characteristic curve indicated that the optimal cutoff point was 4, with sensitivity, specificity, and area under the characteristic curve of 0.90, 0.94, and 0.96, respectively.

Conclusion: The TC-4AT is an accurate tool for delirium assessment that aids early detection and in informed decision-making in preventive care.

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引用次数: 0
Bromocriptine for Residual Catatonia Following Neuroleptic Malignant Syndrome: Illustrative Case Report and Systematic Review. 溴隐亭治疗抗精神病药恶性综合征后残余紧张症:说明性病例报告及系统回顾。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-03 DOI: 10.1016/j.jaclp.2024.12.003
Bernard Sarmiento, Matthew Gunther, Alexis Cohen-Oram, Shixie Jiang

Background: Neuroleptic malignant syndrome (NMS) is a rare yet potentially fatal iatrogenic syndrome that can manifest with life-threatening symptoms. Theorized to be caused by the dopamine-blocking effects of certain medications, such as antipsychotics, or the withdrawal of dopaminergic agents, NMS is characterized by hyperthermia, autonomic instability, altered mental status, and muscular rigidity. Most treated cases resolve within weeks; however, in some cases, residual catatonic symptoms can persist for months after the resolution of acute hyperthermic and hypermetabolic symptoms. The utilization of dopaminergic agents, such as bromocriptine, to alleviate the catatonic symptoms of NMS has been described in the literature but has not been explored systematically.

Objective: The objective of this study is to present a case where high-dose bromocriptine was used to successfully treat significant, residual catatonia following NMS and to further delineate the role of bromocriptine in the management of residual catatonia secondary to NMS through a systematic review.

Methods and results: This study presents an illustrative case report and a systematic review of bromocriptine use in managing residual NMS catatonia. The databases of PubMed, Cochrane, PsycINFO, EBSCO, and OVID Medline were queried, identifying 338 studies. Utilizing COVIDENCE, 137 duplicate articles and 76 irrelevant studies were excluded. Ultimately, 125 studies were assessed for eligibility, yielding 7 manuscripts and 9 total cases of bromocriptine use in residual NMS catatonia. Including our case, bromocriptine use led to an improvement in catatonic symptoms in 80.0% of patients (8 out of 10) and resolved catatonic symptoms in 50.0% of patients (5 out of 10).

Conclusions: Based on this case and the accompanying systematic review, bromocriptine may serve as an effective treatment for residual catatonia following NMS, particularly when first-line strategies such as benzodiazepine and/or electroconvulsive therapy treatment have failed or are infeasible. This highlighted efficacy of bromocriptine may be attributed to relieving persistent dopaminergic blockade in susceptible patients, necessitating further research into the etiological heterogeneity of catatonia.

背景:神经安定剂恶性综合征(NMS)是一种罕见但可能致命的先天性综合征,可表现出危及生命的症状。据推测,NMS 是由某些药物(如抗精神病药)的多巴胺阻断作用或停用多巴胺能药物引起的,其特征是高热、自主神经不稳定、精神状态改变和肌肉僵硬。大多数经过治疗的病例可在数周内缓解;但在某些病例中,急性高热和高代谢症状缓解后,残留的紧张性症状可持续数月之久。利用多巴胺能药物(如溴隐亭)来缓解 NMS 的紧张性症状在文献中已有描述,但尚未进行系统探讨:本研究旨在介绍一例使用大剂量溴隐亭成功治疗NMS后明显残留紧张症的病例,并通过系统综述进一步阐明溴隐亭在治疗NMS继发残留紧张症中的作用:本研究提供了一份说明性病例报告,并对溴隐亭用于治疗残余 NMS 紧张症进行了系统综述。研究人员查询了 PubMed、Cochrane、PsycINFO、EBSCO 和 OVID Medline 等数据库,确定了 338 项研究。利用 COVIDENCE,排除了 137 篇重复文章和 76 篇无关研究。最终,有125项研究通过了资格评估,其中7篇手稿和9个病例涉及溴隐亭在残余NMS紧张症中的应用。包括我们的病例在内,80.0%的患者(10 例中有 8 例)使用溴隐亭后紧张性症状得到改善,50.0%的患者(10 例中有 5 例)紧张性症状得到缓解:根据本病例和随附的系统综述,溴隐亭可作为治疗NMS后残留紧张症的有效药物,尤其是在苯二氮卓和/或电痉挛疗法等一线治疗策略失败或不可行的情况下。溴隐亭的这一突出疗效可能是由于缓解了易感患者体内持续存在的多巴胺能阻滞,因此有必要对紧张性精神障碍的病因异质性进行进一步研究。
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引用次数: 0
Dexmedetomidine in the Intensive Care Unit for Extreme Aggression in a Child With Catatonia. 右美托咪定在重症监护室治疗儿童紧张症的极端攻击。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-03 DOI: 10.1016/j.jaclp.2024.12.006
Samuel Warn, Barrington Hwang, Joshua Smith
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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 : 2025-01-01 DOI: 10.1016/j.jaclp.2024.09.006
Lee M. Dockery M.D., Kristopher A. Kast M.D., Mariah Smith M.D., Lisa S. Stewart M.S.N., M.Ed., Thomas Reese Pharm.D., Ph.D., Andrew D. Wiese Ph.D., Mauli V. Shah M.P.H., David E. Marcovitz M.D.

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
Letter to the Editor: Commentary on “Delirium in the United States: Results From the 2023 Cross-Sectional World Delirium Awareness Day Prevalence Study” by Lindroth et al. (2024) 致编辑的信:Lindroth等人(2024)对“美国谵妄:来自2023年横断面世界谵妄意识日患病率研究的结果”的评论。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.12.002
José Lucas Sena da Silva M.D., Juliana Caldas M.D., Ph.D.
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引用次数: 0
C-L Case Conference: The Interaction Between Emotional Dysregulation and Chronic Critical Illness in a Patient With a Terminal Personality Disorder C-L 病例会议:临终人格障碍患者的情绪失调与慢性重症之间的相互作用。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.08.004
Nathan C. Praschan M.D., M.P.H. , Jordan H. Rosen M.D. , Melissa P. Bui M.D. , O. Joseph Bienvenu M.D., Ph.D.
We present a case of a patient who presented for endocarditis and subsequently had a prolonged and challenging hospital course, with much of it spent in the intensive care unit (ICU). Throughout their hospitalization, personality factors, combined with impaired communication and pain in severe medical illness, led to challenging behaviors of disengagement, impulsivity, splitting, agitation, and suicidal statements. Experts in critical care psychiatry review the case and its key elements, including principles of critical care psychiatry and pharmacologic management of ICU patients; communication problems in ICU patients and associated psychiatric distress; the benefits of proactive consultation for challenging patients; and the construct of post-intensive care syndrome. Patients with personality disorders often struggle to cope with severe medical illness, leading to challenging, self-defeating behaviors. Such acts are even more difficult to manage in intensive care, where a patient's tenuous medical status depends on smooth interactions between them and the medical team. We address how these challenges may be mitigated in collaboration with a psychiatric consult team.
我们介绍了一例因心内膜炎就诊的患者,该患者随后经历了漫长而充满挑战的住院过程,其中大部分时间都在重症监护室(ICU)度过。在整个住院期间,患者的人格因素加上沟通障碍和重症病痛,导致其出现脱离、冲动、分裂、躁动和自杀等具有挑战性的行为。重症监护精神病学专家回顾了该病例及其关键要素,包括重症监护精神病学和重症监护病房患者药物治疗的原则;重症监护病房患者的沟通问题和相关的精神痛苦;对具有挑战性的患者进行主动咨询的益处;以及重症监护后综合征的构建。患有人格障碍的患者往往难以应对严重的内科疾病,从而导致具有挑战性的自我挫败行为。这种行为在重症监护中更加难以控制,因为病人脆弱的医疗状态取决于他们与医疗团队之间的顺利互动。我们将探讨如何通过与精神科咨询团队合作来减轻这些挑战。
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引用次数: 0
Prevalence of Substance Use Disorders Among Patients With Psoriasis and Comorbid Major Depressive Disorder 银屑病合并重度抑郁症患者的药物使用障碍患病率。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.08.008
Xiaofeng Yan M.D., Ph.D., Kevin J. Varghese M.D., James Alan Bourgeois O.D., M.D.
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引用次数: 0
期刊
Journal of the Academy of Consultation-Liaison Psychiatry
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