Journal of the Academy of Consultation-Liaison Psychiatry最新文献

{"title":"The Role of Artificial Intelligence in Consultation-Liaison Psychiatry","authors":"Hochang B. Lee M.D., F.A.C.L.P.","doi":"10.1016/j.jaclp.2025.01.007","DOIUrl":"10.1016/j.jaclp.2025.01.007","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 1","pages":"Pages 1-2"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic and Endocrine Correlates of Subclinical Hypothyroidism in Young Adults With First-Episode and Drug-Naive Major Depressive Disorder","authors":"ZhaoXuan Shang MSc ,&nbsp;ChunQing Fang MSc ,&nbsp;XiaoE. Lang MD, PhD ,&nbsp;Xiangyang Zhang MD, PhD","doi":"10.1016/j.jaclp.2024.10.003","DOIUrl":"10.1016/j.jaclp.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Major depressive disorder 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.</div></div><div><h3>Method</h3><div>A cross-sectional study included 917 young Chinese patients (aged 18–35 years) diagnosed with first-episode, drug-naive Major depressive disorder. Comprehensive clinical assessments were conducted, involving demographic data, psychiatric evaluations using the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Positive and Negative Syndrome Scale, alongside biochemical measurements such as thyroid stimulating hormone, thyroid peroxidase antibodies, fasting blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure. Binary logistic regression identified clinical correlates of SCH.</div></div><div><h3>Results</h3><div>The prevalence of SCH among the study population was 58%. Logistic regression analysis identified significant predictors of SCH, including higher Hamilton Depression Rating Scale scores (odds ratio [OR] = 1.26), thyroid peroxidase antibodies (OR = 1.003), fasting blood glucose (OR = 2.28), total cholesterol (OR = 1.66), systolic blood pressure (OR = 1.11), and diastolic blood pressure (OR = 1.07). In contrast, lower high-density lipoprotein cholesterol levels (OR = 0.28) were inversely associated with SCH.</div></div><div><h3>Conclusion</h3><div>The high prevalence of SCH in young, first-episode, drug-naive Major depressive disorder 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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 1","pages":"Pages 13-26"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversible Lithium-induced Bradycardia in a Patient With Wolff-Parkinson-White Syndrome","authors":"Kristen Dzeda M.D.,&nbsp;Yang Liu B.A.,&nbsp;Rocksheng Zhong M.D., M.H.S.","doi":"10.1016/j.jaclp.2024.09.007","DOIUrl":"10.1016/j.jaclp.2024.09.007","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 1","pages":"Pages 106-107"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Use of a Tricyclic Antidepressant to Address Depression and Quality of Life in a Case of Radiation Proctitis","authors":"Elizabeth Hale M.D.,&nbsp;Patrick Buckley M.D., MBA","doi":"10.1016/j.jaclp.2024.09.002","DOIUrl":"10.1016/j.jaclp.2024.09.002","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 1","pages":"Pages 104-105"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 ACLP Recommendations for Training Residents in Consultation-Liaison Psychiatry","authors":"Scott R. Beach M.D. ,&nbsp;Carrie L. Ernst M.D. ,&nbsp;David C. Fipps D.O. ,&nbsp;Thomas M. Soeprono M.D. ,&nbsp;Mallika Lavakumar M.D. ,&nbsp;Samuel P. Greenstein M.D. ,&nbsp;Thomas W. Heinrich M.D. ,&nbsp;Ann C. Schwartz M.D.","doi":"10.1016/j.jaclp.2024.11.001","DOIUrl":"10.1016/j.jaclp.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>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 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.</div></div><div><h3>Objective</h3><div>These recommendations are intended to guide residency program directors toward optimizing CLP training for all residents, including those who will eventually pursue CLP fellowship.</div></div><div><h3>Methods</h3><div>We convened a workgroup of 8 Academy of Consultation-Liaison Psychiatry members holding leadership positions in residency and fellowship education on local and national levels. The project was approved by the Academy of Consultation-Liaison Psychiatry Executive Council and conducted via a three-stage iterative process.</div></div><div><h3>Results</h3><div>Consensus was reached on 34 recommendations across four domains, including structural issues, faculty supervision, formal curriculum and evaluations, and elective experiences. 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 are essential. A separate and formal CLP didactic curriculum should exist, and elective opportunities should be offered to supplement training.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 1","pages":"Pages 80-89"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Neurofilament Light Associated With Postoperative Delirium in Hip Fracture Repair Patients Without Dementia","authors":"Mfon E. Umoh M.D., Ph.D. ,&nbsp;Haijuan Yan M.S. ,&nbsp;Jeannie-Marie Leoutsakos Ph.D. ,&nbsp;Alexandria Lewis B.A. ,&nbsp;Edward R. Marcantonio M.D., S.M. ,&nbsp;Constantine G. Lyketsos M.D. ,&nbsp;Sharon K. Inouye M.D., M.P.H. ,&nbsp;Abhay Moghekar M.D. ,&nbsp;Karin J. Neufeld M.D., M.P.H. ,&nbsp;Paul B. Rosenberg M.D. ,&nbsp;Frederick Sieber M.D. ,&nbsp;Esther S. Oh M.D., Ph.D.","doi":"10.1016/j.jaclp.2024.10.002","DOIUrl":"10.1016/j.jaclp.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Delirium commonly occurs in older adults following surgery; although its pathophysiology is not fully understood, underlying neurodegeneration is a risk factor.</div></div><div><h3>Objective</h3><div>Examine the association of preoperative levels of markers of neuronal damage, neurofilament light (NfL) and phosphorylated tau (p-tau)₁₈₁, with postoperative delirium.</div></div><div><h3>Methods</h3><div>Preoperative cerebrospinal fluid (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.” 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 a subgroup (<em>n</em> = 134) of patients without dementia.</div></div><div><h3>Results</h3><div>Patients who developed delirium were older, had lower Mini-Mental State Exam score, higher Clinical Dementia Rating and Geriatric Depression Scale 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 (odds ratio 4.74, 95% confidence level 1.21–18.59, <em>P</em> = 0.03) adjusted for age, sex, and Clinical Dementia Rating.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 1","pages":"Pages 3-12"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing and Enabling Patient Communication: Getting Ventilated Patients Talking","authors":"Amy Freeman-Sanderson BAppSc [Speech Pathology], Ph.D. ,&nbsp;Anna-Liisa Sutt B.A., M.A., Ph.D.","doi":"10.1016/j.jaclp.2024.11.004","DOIUrl":"10.1016/j.jaclp.2024.11.004","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 1","pages":"Pages 108-109"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catatonia Associated with Hyperthyroidism: An Illustrative Case and Systematic Review of Published Cases","authors":"Jeremy R. Chaikind M.D. ,&nbsp;Hannah L. Pambianchi B.A. ,&nbsp;Catherine Bledowski M.D.","doi":"10.1016/j.jaclp.2024.11.005","DOIUrl":"10.1016/j.jaclp.2024.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Catatonia is a frequently missed diagnosis on medical wards, delaying effective treatment or permitting accidental use of neuroleptics that can exacerbate the condition. Thyroid storm has rarely been associated with catatonia in case reports, with no prior reviews synthesizing this research.</div></div><div><h3>Objective</h3><div>We present a case of catatonia during thyroid storm following administration of low-dose haloperidol, followed by a review of previously published cases and discussion of their common factors and potential mechanisms.</div></div><div><h3>Methods</h3><div>We first describe a case of a 37-year-old woman with untreated hyperthyroidism and bipolar disorder admitted for mania in the context of thyroid storm. She developed catatonic symptoms after receiving each of two doses of haloperidol. We then present a systematic review of the literature, drawn from the OVID Medline, PsycINFO, and Embase databases, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify case reports of catatonia presenting in association with hyperthyroidism.</div></div><div><h3>Results</h3><div>Seventeen cases were identified—10 in published reports and seven in poster abstracts. The degree of evidence for catatonia varied, with few cases using formal scales. Several cases, including ours, reported recent administration of neuroleptics with dopamine antagonism (29%), usually at relatively low doses or with subsequent tolerance of neuroleptics when euthyroid. Other common factors included a history of psychiatric symptoms (41%) or presence of thyroid autoantibodies (41%).</div></div><div><h3>Conclusions</h3><div>These results are consistent with clinical and preclinical evidence that hyperthyroidism might potentiate dopamine blockade, and they encourage clinicians to minimize neuroleptic use in this population. Other theories have also been proposed for catatonia's association with hyperthyroidism, including direct thyrotoxic effect, autoimmune reaction, and mediation via another secondary psychiatric syndrome (e.g., mania). Clinicians should be aware of the potential for catatonia in thyroid storm, with or without neuroleptic use.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 1","pages":"Pages 67-79"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Onset or Worsening of Psychiatric Symptoms Following Breastfeeding Cessation: An Illustrative Case and Literature Review","authors":"Katherine A. Meidl M.D. ,&nbsp;Bailey N. Brooks M.D. ,&nbsp;Stacey A. Pawlak Ph.D. ,&nbsp;Melissa B. Ludgate M.D.","doi":"10.1016/j.jaclp.2024.10.001","DOIUrl":"10.1016/j.jaclp.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>To increase awareness regarding psychiatric symptom development in the context of breastfeeding cessation.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 1","pages":"Pages 57-66"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zolpidem for the Management of Catatonia: A Systematic Review","authors":"Matthew Gunther M.D., M.A. ,&nbsp;Nathan Tran B.S. ,&nbsp;Shixie Jiang M.D.","doi":"10.1016/j.jaclp.2024.10.004","DOIUrl":"10.1016/j.jaclp.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Catatonia is a psychomotor syndrome associated with neurotransmitter disturbances, common in both psychiatric and medical settings. Hypoactivity of the GABA_A 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.</div></div><div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>We conducted a systematic review using search terms related to zolpidem and catatonia in PubMed, EMBASE, and Web of Science. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and identified 29 studies, including case studies and case series that met inclusion criteria.</div></div><div><h3>Results</h3><div>We reviewed 35 cases in which zolpidem was used for catatonia management (age: mean = 51.5 ± 21.0 standard deviation years; 68.6% female; Bush Francis Catatonia Rating Scale: mean = 22.2 ± 9.0 standard deviation). 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.</div></div><div><h3>Conclusions</h3><div>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 GABA_A receptor. Thus, zolpidem may be an underutilized catatonia treatment and prove useful in situations when benzodiazepines fail or when electroconvulsive therapy 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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 1","pages":"Pages 49-56"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}