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Journal of Psychiatric Practice

Lisa S Richman, Carolyn Garcia, Nicole Bouchard, Philip R Muskin, Amy L Dzierba
BACKGROUND: Alcohol withdrawal is common in hospitalized patients and symptom-triggered guidelines have been shown to reduce treatment duration, length of stay, and need for mechanical ventilation. OBJECTIVES: To assess the feasibility of incorporating symptom-triggered alcohol withdrawal guidelines early in the hospital course and to evaluate outcomes of patients before and after implementation of the guidelines. METHODS: This was a retrospective pre-post study of adult patients admitted from the emergency department to an urban, academic, tertiary care center...
January 2019: Journal of Psychiatric Practice
Nicholas S Patniyot, Irene R Patniyot
The case of a patient with a first presentation psychotic episode secondary to variant Creutzfeldt-Jakob Disease (vCJD) is presented. While psychiatric symptoms are considered a prominent feature of vCJD, they may precede characteristic neurological symptoms, which can delay diagnosis. The psychotic symptoms in this case differed in quality from typical psychotic presentations, which could have helped with earlier diagnosis. The patient's symptomatology suggested that errors in cognition and perception were largely contributing to his psychiatric symptoms...
January 2019: Journal of Psychiatric Practice
Tayfun Kara, Zeynep Topkarci, Zülfikar Gördü, Ismail Akaltun
Gardner-Diamond syndrome (GDS) is a rare disease often seen in young women involving painful localized inflammation and ecchymosis. Ecchymosis usually develops spontaneously after emotional stress. The pathophysiology of the disease is not fully understood, and little is known about management modalities for this syndrome. The primary approach of health professionals in the evaluation of this rare condition should involve identification of cases and investigation of potential accompanying psychiatric pathologies...
January 2019: Journal of Psychiatric Practice
Lauren M Borges, Sarra Nazem, Bridget B Matarazzo, Sean M Barnes, Hal S Wortzel
Structural approaches to suicide risk assessment (eg, evaluating the frequency and intensity of suicidal ideation and classifying types of suicidal behavior) often fall short of providing an idiographic and dynamic analysis of the factors driving and maintaining an individual's suicide risk. Structural approaches can be bolstered through chain analysis which facilitates an exploration of the factors maintaining suicidal ideation and behavior based on positive and negative reinforcement. By uncovering the factors causing suicidal ideation and behavior to persist, efficient intervention strategies can be selected to target these pathways...
January 2019: Journal of Psychiatric Practice
Eric M Plakun
This column, which is the second in a 2-part series on the challenge of treating patients struggling with suicide, reviews one psychodynamic approach to working with suicidal patients that is consistent with the elements shared across evidence-based approaches to treating suicidal patients that were the focus of the first column in this series. Alliance Based Intervention for Suicide is an approach to treating suicidal patients developed at the Austen Riggs Center that is not manualized or a stand-alone treatment, but rather it is a way of establishing and maintaining an alliance with suicidal patients that engages the issue of suicide and allows the rest of psychodynamic therapy to unfold...
January 2019: Journal of Psychiatric Practice
Sheldon H Preskorn
This column is the third in a series exploring drug-drug interactions (DDIs) with a special emphasis on psychiatric medications. The first column in this series discussed why patients being treated with psychiatric medications are at increased risk for taking multiple medications and thus experiencing DDIs and how to recognize such DDIs, and strategies for avoiding them. The second column in the series further discussed strategies for avoiding and/or minimizing adverse outcomes from DDIs. This third column deals with pharmacokinetic considerations concerning DDIs in psychiatric practice...
January 2019: Journal of Psychiatric Practice
Ronnie Solomon, Rachel Shvartsur, Abed N Azab
Mental disorders affect a high percentage of the general population and are associated with a significant burden. One major component of treatment for mental illnesses is pharmacotherapy. Various psychotropic medications are used in the treatment of psychiatric disorders and these are often associated with a plethora of side effects. The many side effects of psychotropic drugs can severely impair patients' quality of life and decrease their adherence to treatment. Among the relatively neglected and less-studied potential side effects of psychotropic drugs are impairment of sperm parameters and fertility problems among male patients...
January 2019: Journal of Psychiatric Practice
Fady Rachid
BACKGROUND: Borderline personality disorder (BPD) is a serious mental disorder characterized by a pervasive pattern of instability in affect regulation and interpersonal relationships, poor self-image and behavioral control, self-injurious behavior, suicidality, and other high-risk behaviors. It is also characterized by a high mortality rate by suicide. METHODS: The published literature on repetitive transcranial magnetic stimulation (TMS), theta-burst stimulation (TBS), and deep TMS in the treatment of BPD were reviewed...
January 2019: Journal of Psychiatric Practice
Oktay Kocabas, Levent Sevincok, Cagdas O Memis, Bilge Dogan
The association of lifetime suicidal behaviors with anxiety disorders (ADs) in patients with bipolar disorder (BD) has been controversial. In this study, we hypothesized that certain types of ADs were related to the occurrence of past suicide attempts (SAs) independent of the severity of the BD, including the presence of past affective episodes. Lifetime diagnoses of BD and ADs were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders (SCID-I)...
January 2019: Journal of Psychiatric Practice
Shana Coshal, Kristin Jones, John Coverdale, Robin Livingston
OBJECTIVE: To inform obstetricians and psychiatrists about the safety of electroconvulsive therapy (ECT) administration during pregnancy and to reconcile conflicting recommendations concerning this treatment. METHODS: A systematically conducted overview was undertaken on the safety of ECT during pregnancy. The Cochrane Library, MEDLINE/PubMed, PsycINFO, and Ovid were independently searched by 2 of the authors from January 2015 to March 2017 using the following search terms: electroconvulsive therapy, ECT, and electroshock combined with pregnancy and reviews...
January 2019: Journal of Psychiatric Practice
John M Oldham
No abstract text is available yet for this article.
January 2019: Journal of Psychiatric Practice
Sabina C Heuss, Bruce J Schwartz, Andres R Schneeberger
BACKGROUND: Although second opinions are rather restricted to the surgical disciplines, they have become more and more important to the health system in the last 20 years. The demand has been triggered by rising health costs and the economization of the field. The Internet has also made a considerable contribution to the demand for patient-initiated second opinions. Given these developments, it is surprising that second opinions have not become more important in the field of psychiatry...
November 2018: Journal of Psychiatric Practice
David A Kahn
Two case reports explore opiate use in relation to 2 different psychiatric disorders. In the first case report, the authors reported the finding that opiate abuse appeared to mitigate premorbid Tourette syndrome in a small series of patients with opiate addiction and that this benefit was maintained with medically supervised opiate agonist therapy. In the second case report, the authors noted a significant correlation between prescription opiate use and delusions of infestation in a large psychodermatology clinic (as well as a separate, stronger correlation with stimulant use)...
November 2018: Journal of Psychiatric Practice
Tian Hao Zhu, Isela A Werchan, Kristin V Escamilla, Katherine Sebastian, Collin A Hovinga, Jason S Reichenberg
OBJECTIVE: Patients diagnosed with delusions of infestation (DOI) at a psychodermatology clinic appeared to have a higher incidence of being prescribed narcotic or stimulant medications compared with the general dermatologic clinic population with chronic pruritic conditions. A retrospective study was conducted examining the correlation between patients with DOI and prescribed psychoactive medications. METHODS: Ninety-two patients with a diagnosis of DOI, seen at our University Psychodermatology Clinic, served as the study population...
November 2018: Journal of Psychiatric Practice
Marija Sarajlija, Diana Raketic, Nada Nesic
INTRODUCTION: Tourette syndrome (TS) is a neurodevelopmental disorder with a high prevalence of psychiatric comorbidity. The most common comorbid disorder in patients with TS is attention-deficit/hyperactivity disorder (ADHD). To date, there have been few reports concerning the association of TS with addiction. METHODS: We report on 4 patients with TS, ADHD, and heroin addiction. RESULTS: All 4 patients were male and initially presented with TS when they were between 5 and 12 years of age, although 2 of the patients were not diagnosed with TS until they were adults...
November 2018: Journal of Psychiatric Practice
Eric M Plakun
This column reviews and discusses recommendations made by individual experts and by expert panels for treating suicidal patients in psychotherapy. Therapies for suicidal patients that were considered for the extraction of shared elements include cognitive behavioral, psychodynamic, and integrated psychotherapies. There is a large amount of convergence among expert consensus recommendations for treating suicidal patients.
November 2018: Journal of Psychiatric Practice
Matthew Macaluso, Sheldon H Preskorn
Several companies offer pharmacogenetic testing for psychiatry on the basis of the claim that the outcome of drug selection is better when guided by such testing than when such testing is not used. This column examines the results of the GeneSight Psychotropic Test which groups various antidepressants and antipsychotics into 3 bins: green ("use as directed"), yellow ("use with caution"), and red ("use with increased caution and more frequent monitoring"). The authors examined how frequently the same drugs appeared in these different bins in 19 patients...
November 2018: Journal of Psychiatric Practice
Reem M A Shafi, Simon Kung, Emily K Johnson, Maria I Lapid, Keith G Rasmussen
OBJECTIVE: Electroconvulsive therapy (ECT) is an effective treatment for depression, but the standard 2 to 3 times weekly treatment course results in a total treatment duration of >2 weeks. We explored the viability of decreasing treatment duration by using daily right unilateral ultrabrief (RULUB) ECT instead of standard bitemporal (BT) ECT. METHODS: This study involved a retrospective review of records of inpatients 18 to 64 years of age who were treated between 2012 and 2017 at a large tertiary ECT center...
November 2018: Journal of Psychiatric Practice
Celia F Hybels, Dan G Blazer, Rae Jean Proeschold-Bell
Religious participation and spirituality are linked to good mental health. However, clergy may experience more depression than is observed in the general population, which may be due in part to high job strain. The objectives of this study were to identify distinct longitudinal trajectories of depressive symptoms in clergy and to identify variables associated with each course. The sample was 1172 clergy who were followed for up to 66 months. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-8), which was administered approximately every 6 months...
November 2018: Journal of Psychiatric Practice
Kim L Gratz, John P Bentley, John Young
Despite growing research on the impact of borderline personality pathology (BPP) on treatment outcomes for emotional disorders among adults, no studies have examined this question in adolescents. Moreover, no studies have examined mediators of the relation between BPP and changes in mood and anxiety symptoms during treatment. This study examined the impact of BPP on treatment outcomes in 141 adolescents in psychiatric residential treatment, as well as the mediating role of change in emotion regulation (ie, adaptive responses to emotions) in the relation between baseline BPP and improvements in psychiatric symptoms during treatment...
November 2018: Journal of Psychiatric Practice
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