Journal of Psychiatric Practice

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

We describe a rare case of acute mania in the setting of autoimmune adrenalitis. A 41-year-old male with no previous psychiatric diagnoses presented with impulsivity, grandiosity, delusions of telepathy, and hyperreligiosity following a previous hospitalization for an acute adrenal crisis and 2 subsequent days of low-dose corticosteroid treatment. Workups for encephalopathy and lupus cerebritis were negative, raising concern that this presentation might represent steroid-induced psychosis. However, discontinuation of corticosteroids for 5 days did not resolve the patient's manic episode, suggesting that his clinical presentation was more likely new onset of a primary mood disorder or a psychiatric manifestation of adrenal insufficiency itself...

Many children with a classification of attention-deficit/hyperactivity disorder exhibit mild-to-moderate problem behavior. For these children, a stepped diagnosis and stepped care approach has been proposed. Although a psychiatric classification may bring support to families, it may also have negative consequences. Therefore, in this preliminary study, the effect of a group parent training program without child-bound classifications (named Wild & Willful, Druk & Dwars in Dutch) was investigated. In 7 sessions, groups of parents (experimental, n=63; waiting list control, n=38) learned strategies to deal with wild and willful behavior in their children...

Although there has been no shortage of technological innovation in recent decades, a solution to sociodemographic disparities in the forensic setting has remained elusive. Artificial intelligence (AI) is a uniquely powerful emerging technology that is likely to either exacerbate or mitigate existing disparities and biases. This column argues that the implementation of AI in forensic settings is inevitable, and that practitioners and researchers should focus on developing AI systems that reduce bias and advance sociodemographic equity rather than attempt to impede the use of this novel technology...

The author describes her struggle with depression and borderline personality disorder, self-harm, and suicidality. She first reviews the long years during which she did not respond to any of the numerous antidepressant medications that were prescribed. She then describes how she finally achieved healing and good functioning as a result of long-term caring psychotherapy in the context of a strong therapeutic relationship in combination with medications that were found to be effective for her symptoms.

The author describes her struggle with depression and borderline personality disorder, self-harm, and suicidality. She first reviews the long years during which she did not respond to any of the numerous antidepressant medications that were prescribed. She then describes how she finally achieved healing and good functioning as a result of long-term caring psychotherapy in the context of a strong therapeutic relationship in combination with medications that were found to be effective for her symptoms.

This column reviews the neurobiology of the sleep-wake cycle as it is currently known, the 7 classes of currently available sleep-enhancing medications, and how their mechanisms of action relate to the neurobiology of sleep. Clinicians can use this information to select medications for their patients, which is particularly important because some patients respond to some of these medications but not others, or tolerate some but not others. This knowledge can also help the clinician switch among classes when a medication that was initially efficacious begins to fail a patient...

BACKGROUND: The cause to which persons experiencing schizophrenia attribute their illness influences emotional and adjustment variables. This is also true for close relatives (CRs), who are important players in the affected individual's environment and whose mood can influence the person's day-to-day life or treatment adherence. Recent literature has highlighted a need to further explore the impact of causal beliefs on different aspects of recovery as well as on stigma. AIMS: The objective of this study was to explore causal beliefs about the illness and their relationship to other illness perceptions and stigma among persons experiencing schizophrenia and their CRs...

OBJECTIVE: The 2016 VA/DoD Clinical Practice Guideline for Management of Major Depressive Disorder offers consensus-based recommendations when response to the initial antidepressant medication is suboptimal; however, little is known about "real-world" pharmacological strategies used by providers treating depression in the Veterans Affairs Health Care System (VAHCS). METHODS: We extracted pharmacy and administrative records of patients diagnosed with a depressive disorder and treated at the Minneapolis VAHCS between January 1, 2010 and May 11, 2021...

OBJECTIVE: Impulsivity is an important risk for suicidality, which is common in patients with major depressive disorder (MDD). The goal of this study was to examine multiple facets of impulsivity in depressed patients compared with healthy controls and to assess their relationship to suicidality. METHOD: Outpatients diagnosed with MDD using the Structured Clinical Interview for DSM-IV were recruited. Two groups were constituted as "MDD in remission" (n=32) and "MDD" (n=71)...

No abstract text is available yet for this article.

OBJECTIVE: Bipolar disorder (BD) is complicated by a dynamic, chronic course along with multiple comorbid psychiatric and medical conditions, making it challenging for clinicians to treat and patients to thrive. To efficiently manage the complexity of BD and help patients recover, we developed a Focused Integrated Team-based Treatment Program for Bipolar Disorder (FITT-BD). The purpose of this paper is to describe how we developed this clinic and the lessons we learned. METHODS: We developed FITT-BD by integrating strategies from stepped care, collaborative care, and learning health care systems...

No abstract text is available yet for this article.

Intentional foreign body ingestions (FBIs) are commonly seen in adult patients with intellectual disabilities, substance use, severe psychiatric conditions, or external motivations, but these cases are rarely reported in the psychiatric literature. We present the case of a patient with an extensive history of FBIs and suicide attempts and a multitude of psychiatric diagnoses including borderline personality disorder, major depressive disorder, posttraumatic stress disorder from significant abuse in foster care, obsessive-compulsive disorder, and pica...

Repeated deliberate ingestion of foreign bodies can have tragic long-term consequences. We report the case of a young woman with borderline personality disorder and chronic posttraumatic stress disorder, whose chronic repeated ingestion of razor blades and batteries eventually resulted in severe medical complications. We focus on the involvement of the consultation-liaison psychiatry team as part of her multidisciplinary care, predominantly in the intensive care environment. Her care posed extensive challenges due to the retraumatizing effects of the intensive care environment and the measures required to provide life-sustaining care when the young woman was emotionally dysregulated...

Assessment of a patient's capacity to make treatment decisions and working with the wishes of a patient with mental illness against the best medically indicated plan is a complex and dynamic task. It is particularly challenging when the course of deterioration of the illness is meandering and slow, and the time horizon for recovery is uncertain, providing no clear point of entry for definitive crisis intervention. High-impact decisions concerning body integrity, such as the amputation of a leg, further complicate the task...

It is clear that exercise can be a source of great support for patients with major depressive disorder. However, it is important to recognize that several multifactorial and intersecting challenges are associated with exercise for this patient population. Group fitness programs for this patient population have the potential to be cost-effective while serving as an avenue of social interaction for participants. From an administrative perspective, it is challenging to balance satisfaction and adherence in group fitness programs targeting patients with major depressive disorder...

This first column in a series on psychodynamic therapy (PDT) offers an overview of the basics required to understand and master the provision of PDT. It offers a way of understanding what patients struggle with when viewed through a psychodynamic lens and then examines evidence-based core elements of psychotherapy and PDT.