Learning DSM-5 by Case Example
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: Book Review Source Type: research

Complex PTSD in ICD-11: A Case Report on a New Diagnosis
The World Health Organization (WHO) has included complex post-traumatic stress disorder (C-PTSD) in the final draft of the 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), which was published in June, 2018 and is scheduled to be submitted to WHO’s World Health Assembly for official endorsement in 2019. Mental health providers will want to be informed about this diagnosis in order to provide effective treatment. Complex PTSD, or developmental PTSD as it is also called, refers to the constellation of symptoms that may result from prolonged, chronic exposure ...
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Paranoid Syndrome as the First Sign of Central Neurocytoma: A Case Report
This report presents the case of a 27-year-old patient with paranoid syndrome without neurological symptoms, in whom magnetic resonance imaging confirmed a large intracranial tumor located predominantly in the right lateral ventricle and third ventricle reaching down to the hypothalamus. Resection of the tumor (histopathologically a CN) resulted in complete remission of the psychotic symptoms. This case supports the need for neuroimaging in all patients with first-episode psychosis because of the possibility of neurologically silent brain tumors. Quick diagnosis in such cases is crucial for the selection of treatment metho...
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

The Potential Perils of a Suicide-specific Diagnosis
The clinical and scientific challenges inherent in treating and investigating suicide warrant novel approaches to this public health issue of paramount importance. The implementation of suicide-specific diagnoses has been proposed as one possible way to address this problem and was described in the first column of this special 2-part series. This second column explores potential unintended consequences related to such proposed diagnoses and alternative solutions that might afford greater benefits. The idea of suicide-specific diagnoses represents a novel approach, and one worthy of further discussion and consideration; the...
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: Columns Source Type: research

Emerging Psychotherapies for Psychosis
Recent developments in the research and clinical literatures have highlighted the importance of focusing on higher-order cognitive processes in the treatment of psychotic disorders. A particular emphasis has been placed on how impairments in self-monitoring and the ability to form mental representations of others uniquely manifest in psychosis. At the same time, the recovery movement has influenced clinical innovations by emphasizing the importance of subjective domains of recovery that privilege the individual’s phenomenological experience. In this column, we outline 2 emerging approaches to the treatment of psychos...
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: Columns Source Type: research

Drug-Drug Interactions (DDIs) in Psychiatric Practice, Part 2: Strategies to Minimize Adverse Outcomes From Unintended DDIs
This column is the second 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. This second column in the series discusses strategies for minimizing adverse outcomes from such unintended DDIs. Given the huge and rapidly increasing number of available prescription and over-the-counter medications as well as nutritional supplements, th...
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: Columns Source Type: research

A New Therapeutic Group To Help Women With Borderline Personality Disorder and Their Infants
Conclusions: This innovative adaptation of mother-infant dialectical behavior therapy showed promising improvements in maternal BPD symptoms and caregiver-infant relationships. Given that the feasibility and safety of this method have been demonstrated, a more methodologically rigorous trial with further refinements appears warranted to help this troubled cohort of patients. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

Diagnosis and Use of Psychotherapy Among Children and Adolescents Prescribed Antipsychotics
Conclusions: Approximately half of the child and adolescent patients prescribed antipsychotics in this community sample did not attend psychotherapy, and 39% of the patients did not have a diagnosis of bipolar disorder, psychotic disorder, or autistic disorder. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

Thiamine Prescribing and Wernicke’s Encephalopathy Risk Factors in Patients With Alcohol Use Disorders at a Psychiatric Hospital
Conclusions: Parenteral thiamine is underutilized in patients with AUD and risk factors for WE. Education is needed to enhance thiamine prescribing and evaluation of risk factors for WE in this population. A thiamine prescribing protocol has been developed for further thiamine optimization. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

PTSD Symptom Severity, but Not Trauma Type, Predicts Mental Health Help-seeking in the Military
Objective: Although veterans with posttraumatic stress disorder (PTSD) have been reported to have high rates of inadequate treatment, to our knowledge this is the first study to evaluate associations between each individual PTSD symptom and treatment-seeking, and the first PTSD help-seeking study to evaluate variables across all—rather than specific—types of trauma. Methods: This case-control study surveyed a consecutive sample of active duty military outpatients with trauma histories (N=211), comparing those attending voluntary mental health services (help-seeking cases, n=128) or mandatory dental service...
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

Attachment
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2018 Category: Psychiatry Tags: From the Editor Source Type: research

Efficacy of Ketamine in Bipolar Depression: Systematic Review and Meta-analysis Retraction
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Retraction Source Type: research

Assessment in Forensic Practice: A Handbook
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Book Review Source Type: research

Trauma Does Not Predict Patients’ Experiences With Constant Observation
Conclusions: Neither PTSD nor trauma history predicts a negative or positive experience with CO. A predictive model regarding which patients are likely to experience CO positively or negatively remains to be established. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Practitioner's Corner Source Type: research

Treatment of Comorbid Adult Attention-deficit/Hyperactivity Disorder and Generalized Anxiety Disorder: 2 Case Reports
In this report, we present 1 case in which we treated adult ADHD first and 1 case in which we treated generalized anxiety disorder before prescribing any medication for ADHD. More studies are required on this topic, but our results suggest that treating anxiety disorders until a clear reduction of anxiety symptoms is observed, or at least taking a combined treatment approach, is more appropriate than treating adult ADHD alone and waiting for a reduction in anxiety symptoms as a secondary effect. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Is Ketamine the Future Clozapine for Depression? A Case Series and Literature Review on Maintenance Ketamine in Treatment-resistant Depression With Suicidal Behavior
Ketamine has shown effectiveness as a rapid-acting antidepressant with antisuicidal effects in terms of reduction of suicidal ideation in the short term. However, the evidence for long-term maintenance ketamine therapy for treatment-resistant depression (TRD) and suicidal behavior is limited. This case series (N=13) highlights the role of adjunctive serial maintenance ketamine infusions in restoring functionality in treatment-resistant unipolar and bipolar (mixed) depression with significant suicide risk and multiple comorbidities, including alcohol dependence. Two cases of TRD achieved functional remission with long-term ...
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Whether Called Acute Suicidal Affective Disturbance or Suicide Crisis Syndrome, a Suicide-specific Diagnosis Would Enhance Clinical Care, Increase Patient Safety, and Mitigate Clinician Liability
Separate research groups have independently argued the need for a suicide-specific diagnosis within the psychiatric diagnostic nomenclature. Although a suicide-specific diagnosis could possibly enhance clinical care and improve patient safety, some clinicians have expressed concerns regarding the legal risk of utilizing a suicide-specific diagnosis. In this column, the first of a 2-part series exploring the potential risks and benefits of a suicide-specific diagnosis, the authors draw from their decades of experience in clinical work, legal consulting, as well as the litigation of suicide and wrongful death lawsuits and co...
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Columns Source Type: research

Efficacy of Ketamine in Bipolar Depression: Systematic Review and Meta-analysis Retraction
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Retraction Source Type: research

Assessment in Forensic Practice: A Handbook
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Book Review Source Type: research

Trauma Does Not Predict Patients’ Experiences With Constant Observation
Conclusions: Neither PTSD nor trauma history predicts a negative or positive experience with CO. A predictive model regarding which patients are likely to experience CO positively or negatively remains to be established. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Practitioner's Corner Source Type: research

Treatment of Comorbid Adult Attention-deficit/Hyperactivity Disorder and Generalized Anxiety Disorder: 2 Case Reports
In this report, we present 1 case in which we treated adult ADHD first and 1 case in which we treated generalized anxiety disorder before prescribing any medication for ADHD. More studies are required on this topic, but our results suggest that treating anxiety disorders until a clear reduction of anxiety symptoms is observed, or at least taking a combined treatment approach, is more appropriate than treating adult ADHD alone and waiting for a reduction in anxiety symptoms as a secondary effect. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Is Ketamine the Future Clozapine for Depression? A Case Series and Literature Review on Maintenance Ketamine in Treatment-resistant Depression With Suicidal Behavior
Ketamine has shown effectiveness as a rapid-acting antidepressant with antisuicidal effects in terms of reduction of suicidal ideation in the short term. However, the evidence for long-term maintenance ketamine therapy for treatment-resistant depression (TRD) and suicidal behavior is limited. This case series (N=13) highlights the role of adjunctive serial maintenance ketamine infusions in restoring functionality in treatment-resistant unipolar and bipolar (mixed) depression with significant suicide risk and multiple comorbidities, including alcohol dependence. Two cases of TRD achieved functional remission with long-term ...
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Whether Called Acute Suicidal Affective Disturbance or Suicide Crisis Syndrome, a Suicide-specific Diagnosis Would Enhance Clinical Care, Increase Patient Safety, and Mitigate Clinician Liability
Separate research groups have independently argued the need for a suicide-specific diagnosis within the psychiatric diagnostic nomenclature. Although a suicide-specific diagnosis could possibly enhance clinical care and improve patient safety, some clinicians have expressed concerns regarding the legal risk of utilizing a suicide-specific diagnosis. In this column, the first of a 2-part series exploring the potential risks and benefits of a suicide-specific diagnosis, the authors draw from their decades of experience in clinical work, legal consulting, as well as the litigation of suicide and wrongful death lawsuits and co...
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Columns Source Type: research

Rural Assertive Community Treatment and Telepsychiatry
Assertive community treatment (ACT) is an evidence-based treatment for patients with severe and persistent mental illness. ACT has been shown to reduce inpatient hospitalization and is increasingly being used as a mainstay of evidence-based psychiatric practice for these clinical populations. The increasing implementation of evidence-based practices has led to the expansion of ACT in rural areas. Variability in the adaptation of ACT in rural areas has included accommodation by teams to multiple barriers. One way to increase psychiatric professional efficiency in rural areas is with telepsychiatry and possibly with rural AC...
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Columns Source Type: research

Drug-drug Interactions in Psychiatric Practice, Part 1: Reasons, Importance, and Strategies to Avoid and Recognize Them
This column begins a series exploring drug-drug interactions (DDIs) with a special emphasis on psychiatric medications. As explained in this column, this topic is important for multiple reasons. First, a large percentage of the population is receiving psychiatric medications. Second, these patients are likely to be on multiple medications which means that they are at risk for an adverse DDI. Third, DDIs may occur but not be recognized even though they have significant health care consequences for the patient. Fourth, these consequences can range from a catastrophic outcome to more everyday clinical problems involving a myr...
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Columns Source Type: research

Religious Activity, Psychotic Features, and Suicidality in 688 Acute Psychiatric Inpatients
This study examined the potential relationship between religiosity and demographic and clinical variables in a sample of psychiatric inpatients. Methods: In total, 688 adults admitted to an acute psychiatric facility with a primary mood or psychotic disorder completed the Duke University Religion Index (DUREL). The DUREL measures religious activity in 3 domains: organizational religious activity (ORA), nonorganizational religious activity (NORA), and intrinsic (or subjective) religiosity (IR). We categorized scores into high and low religiosity. Bivariate analyses with χ2 and independent sample t tests were used to ...
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

The Developmental Profile Inventory: Constructing a Clinically Useful Self-Report for Levels of Psychodynamic Personality Functioning
Conclusions: The DPI is a promising self-report measure for assessing both adaptive and maladaptive patterns of psychodynamic personality functioning. The appropriate initial psychometric properties justify proceeding with more formal tests of construct validity and predictive performance in broader mental health settings. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

Scientific Evidence for the Evaluation of Neurological Soft Signs as Atypical Neurodevelopment Markers in Childhood Neuropsychiatric Disorders
Motor dysfunction is commonly present in children with neurodevelopmental disorders. Developmental changes in voluntary control of motor skills include improvements in speed and motor coordination as well as reduced frequency of neurological soft signs (NSS) that are commonly observed in typically developing younger children. NSS are motor and sensory conditions that cannot be linked to specific cerebral lesions. The persistence of NSS into later childhood and adolescence is linked with an increased risk of psychiatric disorders. This finding gives support to the neurodevelopmental model of NSS in which minor neurological ...
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

Visual Attention Affects the Amplitude of the Transcranial Magnetic Stimulation-associated Motor-evoked Potential: A Preliminary Study With Clinical Utility
Conclusions: The significant effect of visual attention on MEP suggests that this should be a standardized parameter in clinical and research studies. These data underscore the importance of rigorous reporting of methods and use of standardized practices for MEP acquisition and TMS dosing to ensure consistent clinical measurement and treatment. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

Predicting Suicide
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2018 Category: Psychiatry Tags: From the Editor Source Type: research

DSM-5 Pocket Guide for Elder Mental Health
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: Book Review Source Type: research

Does Involuntary Admission With Bipolar Disorder Differ From Involuntary Admission With Schizophrenia and Related Disorders? A Report From the Dublin Involuntary Admission Study (DIAS)
Background: While involuntary psychiatric admission and treatment are common, little is known about what impact different diagnoses have on specific features of involuntary admission and on how involuntary status is terminated (eg, by psychiatrists or tribunals, which are independent, court-like bodies reviewing involuntary admissions). Methods: We studied 2940 admissions, 423 (14.4%) of which were involuntary, at 3 psychiatry units covering a population of 552,019 individuals in Dublin, Ireland. Results: Involuntary patients were more likely than voluntary patients to be male and unmarried. The median length of st...
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: Practitioner’S Corner Source Type: research

Brain and Behavior: Commentary on Two Cases Involving the Effect of Structural Brain Lesions on Psychiatric Disorders
In this issue of the journal, 2 case reports are presented that illustrate explicit influences of structural brain lesions on psychiatric symptoms. In both cases, the patients had preexisting, classically diagnosed psychiatric disorders—schizophrenia in the first case and bipolar I disorder in the second case. In the first case, a 61-year-old woman with chronic paranoid schizophrenia experienced a marked reduction in psychotic symptoms after bilateral frontal strokes. In the second case, a 60-year-old man who had experienced manic and depressive episodes since his 20s developed partial complex seizures after having r...
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Differentiating Symptoms of Bipolar Disorder From Those of Temporal Lobe Epilepsy: A Case Report
We describe an individual with a history of bipolar I disorder who developed right temporal lobe epilepsy after several head injuries. He subsequently exhibited symptoms consistent with interictal personality syndrome that were independent of his bipolar symptomatology. Better understanding of these disorders can lead to improved diagnosis and symptom management. The similarities may also point to a partially shared neuropathology. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Poststroke Psychosis Reduction: A Case Report
In this report, we review poststroke psychiatric manifestations, and then present the case of a woman with schizophrenia whose thought disorder improved following a hemorrhagic stroke. Not only did she require less medication, but her remaining symptoms were significantly less impairing than they had previously been. We then compare and contrast the effects of this stroke with ablative neurosurgery. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity
The founding members of the Coalition for Psychotherapy Parity present Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity. These guidelines support access to psychotherapy as prescribed by the clinician without arbitrary limitations on duration or frequency. The authors of the guidelines first review the evidence that psychotherapy is effective, cost-effective, and often provides a cost-offset in decreased overall medical expenses, morbidity, mortality, and disability. They highlight the disparity between clinicians’ knowledge of gen...
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: Column Source Type: research

Predictors of Lifetime Suicide Attempts in Individuals With Attenuated Psychosis Syndrome
Conclusions: Suicidality is a prominent feature of APS, and a number of risk factors increase the likelihood of suicide attempts in this population. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

Perinatal Mental Health Treatment Needs, Preferences, and Barriers in Parents of Multiples
Conclusions: There is a large, unmet need for mental health treatment in parents of multiples in the perinatal period, especially the early postpartum months. eHealth strategies seem particularly feasible and acceptable in this population and may help circumvent common barriers to care. Clinical recommendations and considerations in treatment development are discussed. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

Symptom Dimensions and Trajectories of Functioning Among Bipolar Youth: A Cluster Analysis
This study used a full diagnostic instrument to examine symptom patterns among youth with BD. Method: Trained interviewers completed the Washington University Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) with 71 children (7 to 13 y of age) and families as part of the baseline assessment for a randomized clinical trial of Child- and Family-focused Cognitive-Behavioral Therapy (CFF-CBT) compared with treatment as usual (TAU) for pediatric BD. All participants met DSM-IV-TR criteria for a bipolar spectrum disorder. Hierarchical and K-means cluster analyses were performed. Resultant cluste...
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

Characteristics of Successful Transitions From Inpatient to Outpatient Electroconvulsive Therapy
Objectives: The purpose of this study was to identify clinical and psychosocial factors involved in transitioning hospitalized patients receiving electroconvulsive therapy (ECT) from the inpatient to the outpatient setting and to propose an algorithm to guide clinicians with this process. Methods: A retrospective chart review was completed for adult patients discharged from a psychiatric hospital from 2002 to 2012 who had an acute course of ECT that was initiated in the hospital and completed as an outpatient. We reviewed demographic and clinical information and outcomes, including ECT treatments. Results: Among th...
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: Articles Source Type: research

Multiples
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2018 Category: Psychiatry Tags: From the Editor Source Type: research

Bipolar, Not So Much: Understanding Your Mood Swings and Depression
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - March 1, 2018 Category: Psychiatry Tags: Book Review Source Type: research

Beyond Social Media: A Cross-Sectional Survey of Other Internet and Mobile Phone Applications in a Community Psychiatry Population
Conclusions: Our findings indicate that use of several popular forms of media is not uncommon in a community psychiatry population, but that rates of use differ on the basis of age and education. As the digital divide between people with severe mental illness and the general population is lessening, further research is needed to determine how to best leverage various types of media to support mental health recovery and complement clinical care. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - March 1, 2018 Category: Psychiatry Tags: Practitioner's Corner Source Type: research

Commentary on 2 Cases of Rare but Serious Side Effects of Commonly Used Medications: Dilemmas in Clinical Decision-making
In this issue of the journal, 2 case reports are presented that describe rare but serious side effects of commonly used medications. These cases illustrate dilemmas in clinical decision-making. The first describes the induction of seizures by low-dose venlafaxine in a predisposed individual, and the second describes the development of mild but significant leukopenia with sequential trials of olanzapine and risperidone. The association between a drug and a rare but potentially serious side effect in an individual patient can be difficult to determine with precision, and the decision to press ahead and try to work around the...
Source: Journal of Psychiatric Practice - March 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Olanzapine-induced and Risperidone-induced Leukopenia: A Case of Synergistic Adverse Reaction?
We report a case of an antipsychotic-naive patient with schizophrenia who developed leukopenia after a single dose of olanzapine, which worsened during subsequent treatment with risperidone. Normalization of the white blood cell counts occurred within 24 hours of risperidone discontinuation. Possible synergistic mechanisms underlying olanzapine-induced and risperidone-induced leukopenia are discussed. This case highlights the challenges in identifying and managing nonclozapine antipsychotic-induced leukopenia in a susceptible patient. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - March 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Seizure Induced by a Therapeutic Dose of Venlafaxine ER: A Case Report
We report the case of a 44-year-old woman undergoing antituberculosis therapy who suffered complex partial seizures after ingestion of a low therapeutic dose of venlafaxine extended release (ER). Her first seizure was observed soon after venlafaxine ER was titrated from 37.5 to 75 mg daily, with a total of 9 witnessed complex partial seizures. After titrating the dose of the venlafaxine ER back down to 37.5 mg daily and beginning lamotrigine anticonvulsant therapy, the patient exhibited no further seizures. The development of seizure activity under therapeutic dosing of venlafaxine should be brought to the at...
Source: Journal of Psychiatric Practice - March 1, 2018 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Clinical and Insurance Perspectives on Intermediate Levels of Care in Psychiatry
This column compares a clinical perspective on the continuum of care for mental health and substance use disorders with a different perspective derived from publicly available insurance company documents and experience dealing with managed care utilization reviewers. The latter perspective tends to determine the need for access to levels of care based on the need for crisis stabilization, whereas the generally accepted clinical standard is more nuanced than the need for crisis stabilization alone. The column proposes that this discrepancy in perspectives makes a substantial contribution to disagreements between treating cl...
Source: Journal of Psychiatric Practice - March 1, 2018 Category: Psychiatry Tags: Columns Source Type: research

CNS Drug Development, Lessons Learned, Part 5: How Preclinical and Human Safety Studies Inform the Approval and Subsequent Use of a New Drug—Suvorexant as an Example
This column is the fifth in a series examining the advances being made in central nervous system drug development because of advances in molecular pharmacology and an improved understanding of the neurobiology underlying disturbances in brain function including psychiatric illnesses. This column covers the special animal and human studies conducted as part of the development of suvorexant, which is the first in the class of dual orexin 1 and 2 receptor antagonists to be approved; it has an indication for the treatment of disturbances in sleep onset and maintenance. The animal studies included determination of the therapeut...
Source: Journal of Psychiatric Practice - March 1, 2018 Category: Psychiatry Tags: Columns Source Type: research

Does Late-onset Anorexia Nervosa Exist? Findings From a Comparative Study in Singapore
Conclusions: Although differences exist between early-onset and late-onset cases of AN, these are few. Until stronger evidence emerges over time, there currently seems to be minimal justification to accord late-onset AN a unique position in psychiatric nosology. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - March 1, 2018 Category: Psychiatry Tags: Articles Source Type: research