Student Mental Health: A Guide for Psychiatrists, Psychologists, and Leaders Serving in Higher Education
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Book Reviews Source Type: research

A Dark Night in Aurora: Inside James Holmes and the Colorado Mass Shootings
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Book Reviews Source Type: research

Transcranial Magnetic Stimulation: A Clinical Primer for Nonexperts
Transcranial magnetic stimulation (TMS) is a safe and effective therapeutic modality for a rapidly expanding range of neuropsychiatric indications. Among psychiatric conditions, it is presently approved by the US Food and Drug Administration for treatment-resistant unipolar major depressive disorder and obsessive-compulsive disorder, 2 highly prevalent conditions with a considerable public health impact. There is also mounting evidence for its clinical utility in numerous other neuropsychiatric conditions. Nonetheless, many mental health providers, as well as primary care and other providers, remain unfamiliar with its cli...
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Practitioner’s Corner Source Type: research

Severe Hypothyroidism Manifested as Acute Mania With Psychotic Features: A Case Report and Review of the Literature
We present the case of a 26-year-old woman with no known psychiatric history who presented with gradual onset of altered mental status, distractibility, decreased need for sleep, pressured speech, and religious and paranoid delusions. Her medical history was significant for a surgically absent thyroid gland and nonadherence to thyroid hormone. The patient was found to have a severely elevated level of thyroid-stimulating hormone, low level of triiodothyronine, and undetectable thyroxine. Thyroid ultrasound demonstrated a surgically absent thyroid gland. The patient’s metabolic panel and random serum cortisol level we...
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Attempted Suicide in a Woman With Steroid-responsive Encephalopathy Associated With Autoimmune Thyroiditis: A Case Report
We present the case of a young woman diagnosed with SREAT who presented after a suicide attempt. Although signs and symptoms of depression, psychosis, and mania have been well described as potential manifestations of the disorder, attempted suicide as a primary presentation of SREAT has not been well captured in the current literature. In fact, it appears that suicidal thoughts and attempts are not nearly as prevalent as would be expected given the high prevalence of psychiatric signs and symptoms in the disorder, but rather, they appear to be quite rare phenomena. In this case report, we identify other articles in the lit...
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Therapeutic Risk Management for Violence: Augmenting Clinical Risk Assessment With Structured Instruments
Violence risk assessment is a requisite component of mental health treatment. Adhering to standards of care and ethical and legal requirements necessitates a cogent process for conducting, and then documenting, other-directed violence risk screening, assessment, and management. In this 5-part series, we describe a model for achieving therapeutic risk management of the potentially violent patient, with essential elements involving: clinical interview augmented by structured screening or assessment tools; risk stratification in terms of temporality and severity; chain analysis to intervene on the functions of violent ideatio...
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

COVID-19: Preliminary Data on the Impact of Social Distancing on Loneliness and Mental Health
The COVID-19 pandemic and its need for social distancing as a response have the potential to increase the experience of loneliness in the population, with an associated increase in symptoms of mental disorders. As the world has largely adapted to remote platforms for employment, socializing, and health service delivery, the degree to which virtual opportunities for social engagement may offset the impact of limited in-person interactions on mental health functioning is unknown. This column offers preliminary data from an ongoing experience sampling study of the prevalence, course, and impact of loneliness on mental health ...
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

COVID-19: Why Has the Mortality Rate Declined?
This article explains how the mortality rate of an illness such as Coronavirus Disease 2019 (COVID-19) is calculated as well as how the definition of what is a “case” has changed from the earliest days of the pandemic to now. Many factors were not known about The Sudden Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) which causes COVID-19 at the beginning of the pandemic because it is a novel human pathogen. One key factor that was not known in the earliest days of the pandemic was that many patients are either asymptomatic or have symptoms so mild that they may not seek medical attention and hence these ...
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

Pharmacological Treatment for Comorbid Bipolar Disorder and Obsessive-Compulsive Disorder in Adults
Comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is fairly common, and the treatment of these conditions when comorbid is challenging. Serotonin reuptake inhibitors, the first option for treatment of OCD, can worsen BD symptoms, and mood stabilizers are generally not efficacious for OCD. Our goal in this article is to assess the clinical effectiveness of pharmacotherapies for comorbid BD-OCD in adults. We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases on April 30, 2017, and we also searched the reference lists of identified articles. Studies publi...
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

A Systematic Review of Barriers Faced by Older Adults in Seeking and Accessing Mental Health Care
Older adults in the United States have lower rates of mental health care utilization than young adults. To understand these lower rates of mental health care, we performed a systematic review, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of barriers that prevent older adults from seeking and accessing treatment. We searched PubMed, PsycINFO, and Clinical Key to identify studies of barriers to mental health treatment in the older adult population (in individuals 50 y of age and older). Thirty-two articles met inclusion criteria (English language and focuse...
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

Lithium Prescribing and Therapeutic Drug Monitoring in Bipolar Disorder: A Survey of Current Practices and Perspectives
Conclusion: Shifts in prescribing practices, inconsistent interpretation of lithium levels, and concerns about safety and therapeutic drug monitoring highlight the need for evidence-informed guidelines reflective of current practice. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

Assessing Mental Representation as an Indicator of Self and Interpersonal Functioning in Psychotherapy Patients
The goal of this study was to test in a clinical sample the interrater reliability and convergent validity of the Differentiation-Relatedness Scale (D-RS), a measure that evaluates mental representations based on open-ended descriptions of self and significant others. The study also investigated the ability of the D-RS to predict personality disorders (PDs) from Section II of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the dysfunctional trait domains presented in the Alternative DSM-5 Model for Personality Disorders Criterion B in Section III of the DSM-5. We also evaluated if the ...
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

Risk Assessment
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2020 Category: Psychiatry Tags: From the Editor Source Type: research

Lifestyle Psychiatry
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Book Review Source Type: research

Twelve-Month Analysis of Nonattendance for Initial Assessment in a Resident Outpatient Psychiatry Clinic
Conclusions: Younger age, lack of insurance, major holidays, and longer waiting periods before the appointment were associated with nonattendance for the initial assessment in this outpatient resident clinic. This information can be helpful in developing interventions to improve attendance for the first step in engaging in psychiatric care. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Practitioner’s Corner Source Type: research

Integration of Clozapine-associated Harm Obsessions into Cognitive Behavioral Conceptualization and Treatment Planning for Thought Broadcasting: A Case Study
Conclusions: This report presents a means of conceptualizing the interplay between thought broadcasting and harm obsessions and discusses considerations in identifying and treating individuals with similar comorbid conditions, particularly in the context of clozapine treatment for medication-resistant psychosis. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Practitioner’s Corner Source Type: research

Commentary on “Window to His World: Using a Patient’s YouTube Channel to Help Diagnose Chronic Mania”
We present the case of a manic patient who was hospitalized and subsequently found to have a YouTube channel that he had been using to promote his self-invented religion for over 2 years. Consent was obtained from the patient to review this YouTube channel for collateral information. From these videos, the patient was seen to be chronically circumstantial in his thought processes, grandiose in his ideas, highly energetic, distractible, preoccupied with religion, and talking with elaborate and rapid speech. A significant improvement in his symptoms was observed after administration of oral risperidone, with his scores on th...
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Window to His World: Using a Patient’s YouTube Channel to Help Diagnose Chronic Mania
We present the case of a manic patient who was hospitalized and subsequently found to have a YouTube channel that he had been using to promote his self-invented religion for over 2 years. Consent was obtained from the patient to review this YouTube channel for collateral information. From these videos, the patient was seen to be chronically circumstantial in his thought processes, grandiose in his ideas, highly energetic, distractible, preoccupied with religion, and talking with elaborate and rapid speech. A significant improvement in his symptoms was observed after administration of oral risperidone, with his scores on th...
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Reconsidering Rigidity in the Diagnosis of Neuroleptic Malignant Syndrome: A Case Report
In this report, we present a case in which a patient’s antipsychotic regimen during a psychotic episode (which involved both typical and atypical antipsychotics) subsequently led to NMS. During his stay, the patient developed an altered level of consciousness, elevation of creatine phosphokinase, hemodynamic instability, and a fever. However, the patient did not have signs of rigidity, the cardinal sign of this syndrome. The authors concluded that patients could develop NMS without rigidity while receiving an antipsychotic. Given this presentation, the authors suggest that clinicians have a high level of suspicion fo...
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Therapeutic Risk Management for Violence: Clinical Risk Assessment
Violence risk assessment is a requisite component of mental health treatment. Adhering to standards of care and ethical and legal requirements necessitates a cogent process for conducting (and documenting) screening, assessment, and management of other-directed violence risk. In this 5-part series, we describe a model for achieving therapeutic risk management of the potentially violent patient, with essential elements involving a clinical interview augmented by structured screening or assessment tools; risk stratification in terms of temporality and severity; chain analysis to intervene on the functions of violent ideation...
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

Psychotherapy in the Post-COVID-19 Era
This column anticipates challenges likely to be faced by psychotherapists and their patients after the coronavirus disease 2019 (COVID-19) pandemic subsides. It looks beyond the current impact of loneliness, isolation, thwarted belongingness, and loss toward the longer term impact of moral injury and blocked opportunities for mourning. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

Two Clinically Important but Underutilized and Misunderstood Tools: Formulas to Estimate Creatinine Clearance and Therapeutic Drug Monitoring
This column first reviews 2 key equations that are central to clinical pharmacology. Clinicians can use the first equation to predict the effect of a specific dose of a specific drug in specific circumstances on the basis of 3 variables: (1) the drug’s pharmacodynamics, (2) the drug’s pharmacokinetics, and (3) biological variance in the individual patient. Clinicians can use the second equation to determine the concentration of a drug that a patient will achieve on a given dose depending on the patient’s ability to clear the drug from the body. These 2 equations allow prescribers to predict whether the do...
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

Race, History of Abuse, and Homelessness Are Associated With Forced Medication Administration During Psychiatric Inpatient Care
Objective: Although previous research has suggested that racial disparities exist in the administration of forced medication (FM) in psychiatric inpatients, data remain scarce regarding other contributing variables. Therefore, this study examined sociodemographic and clinical variables associated with FM administration in psychiatric inpatients. Methods: Electronic medical records from 57,615 patients admitted to an academic psychiatric hospital between 2010 and 2018 were reviewed to identify patients who received FM. These records indicated that FM petitions were requested and approved for ∼6200 patients. Patient...
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Winner of Resident Paper Award 2019 Source Type: research

Promoting Medication Adherence Among Psychiatric Patients With a History of Nonadherence: A Clinical Practice Improvement Program
Conclusions: Quality improvement methodologies can be used to solve common problems with context-specific solutions. The implementation of person-centered medication adherence counseling led by an advanced practice nurse in concert with optimization of medication regimens appears to be a promising strategy for improving adherence in nonadherent patients admitted to the psychiatric ward. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

Cognitive Remediation for Outpatients With Recurrent Mood Disorders: A Feasibility Study
Current first-line treatments for mood disorders often improve mood symptoms but do little to reduce cognitive and functional impairment. This 10-week, uncontrolled, feasibility study evaluated a cognitive remediation (CR) intervention for individuals with recurrent mood disorders. Adults with recurrent major depressive disorder or bipolar disorder, who had recently been treated and discharged from specialized mental health services, were eligible for inclusion. Twenty patients completed the CR intervention, which involved weekly individual sessions with a therapist, as well as the practice of computerized CR exercises bet...
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

Mental Health and Social Care Professionals After a Patient Suicide: Interrelation Between Support Needed, Sought, and Received
This article investigates the support needed, sought, and received by professionals following a patient suicide. A self-administered questionnaire about the consequences of patient suicide and support issues was completed by 704 professionals. Profiles of support were defined using a 3-dimensional, 8-fold typology based on need for, search for, and sufficiency of support. Stress reactions, professionals’ characteristics, relationship with the patient, training, and providers of support were used to characterize the profiles. Most professionals acknowledged receiving sufficient support to manage the aftermath of patie...
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

A Turbulent World
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2020 Category: Psychiatry Tags: From the Editor Source Type: research

Family Murder: Pathologies of Love and Hate
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Book Review Source Type: research

Bringing Psychiatry into the Mosque: Analysis of a Community Psychoeducation Intervention
Conclusions: The findings of this study suggest the potential effectiveness of coordinated interventions by religious leaders and mental health professionals to address the reluctance of Muslims to use psychotropic medication treatment when indicated. Limitations of this study include the self-selection of a highly-educated subset of the greater Muslim population that may already have been interested in a mental health symposium. For the future, research should consider the use of psychoeducation in general religious services to reach a more representative sample of practicing Muslims. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Practitioner’s Corner Source Type: research

Clinical Use of Prazosin in a Patient With Acute Stress Disorder: A Case Report
We present the case of a 51-year-old man who was experiencing symptoms of ASD following a motor vehicle accident that occurred a few days earlier. He was reporting flashbacks and nightmares of the accident, but after being treated with prazosin, his symptoms completely resolved. Prazosin may be effective in treating the symptoms of ASD and, by doing this, it may also play a role in inhibiting the progression of ASD to PTSD. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Pseudologia Fantastica: An Elaborate Tale of Combat-related PTSD
We describe the patient’s presentation and the careful process of confrontation and acquisition of collateral information used to reach the diagnosis, along with the patient’s efforts to avoid accepting the truth by constructing a series of even more elaborate stories. Finally, we underscore the importance of maintaining a therapeutic alliance in caring for patients with PF through frequent displays of uniform positive regard, and we describe the approach to treatment used during the patient’s hospital stay. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Therapeutic Risk Management: Suicide Postvention
When considering critical elements involved in suicide prevention, dialogs are often dominated by suicide assessment, management, and intervention themes. Proactive consideration on what to do if a patient dies by suicide is often overlooked, which can be especially detrimental to our practice and those we serve. In this article, we extend the philosophy of the therapeutic risk management model to consider ways in which we can take good care of the extended community of suicide loss survivors, including providers. We begin by briefly describing the widespread impact of suicide loss and the lack of suicide postvention educa...
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

The Mental Health Crisis in America: Recognizing Problems; Working Toward Solutions: Part 3. Access to Care
This column is the third in a series summarizing the 2-day Centennial Conference of the Austen Riggs Center. The conference framed problems in access to care and in the nature of care provided that are part of a mental health crisis in America and then worked to propose solutions. This column addresses problems with access to care and summarizes the conference’s closing keynote by Peter Fonagy, PhD, OBE, addressing issues both of access to care and of the nature of care provided. These issues play roles in ultimately “bending the curve” to improve outcomes for those struggling with mental and substance us...
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

The 5% of the Population at High Risk for Severe COVID-19 Infection Is Identifiable and Needs to Be Taken Into Account When Reopening the Economy
The goal of this column is to help mental health care professionals understand coronavirus disease 2019 (COVID-19) so that they can better explain the complexities of the current crisis to their patients. The bottom-line of this column is that, while COVID-19 can infect virtually everyone in the human population, only about 5% are susceptible to severe infection requiring admission to an intensive care unit and/or causing a fatal outcome and this population can be identified on the basis of comorbid medical illness and/or age. These numbers are based on experience in China, the United States, and Europe. Table 1 presents a...
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

Mental Health Care Providers Dealing With Coronavirus Disease 2019 (COVID-19): What Is the Definition of a Case, How Is That Changing, and What Kinds of Tests Are Available?
The goal of this column is to inform mental health care professionals about the evolving way the diagnosis of Coronavirus Disease 2019 (COVID-19) is being made, with emphasis on tests to assist in making the diagnosis and to determine the presence of antibodies to the virus. This column also provides some general information about the disease, its relative risks, and efforts to develop effective treatments. Links to credible websites that are being continuously updated are also provided for readers who want more information and to stay current with ongoing developments. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

Postpartum Mental Health Care for Mothers of Multiples: A Qualitative Study of New Mothers’ Treatment Preferences
Conclusions: This study lays the groundwork for the development of a targeted psychosocial intervention to address mental health concerns among new mothers of multiples, particularly those who are already engaged and seeking support and community online. This report also suggests myriad ways in which providers can best address the needs of this population (eg, utilize providers with expertise in multiples, deliver care in the home, use e-health approaches, and normalize unique stressors and negative moods). (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

Panic Disorder Correlates With the Risk for Sexual Dysfunction
Conclusions: Although the results were mixed, it appears that patients with panic disorder tended to be more susceptible to sexual dysfunction than the general population. Further trials with larger sample sizes and rigorous research designs are needed to establish the relationship between sexual dysfunction and panic disorder. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

Obsessive-Compulsive Disorder in Older Adults: A Comprehensive Literature Review
We reviewed English-language articles concerning obsessive-compulsive disorder (OCD) in older adults. PubMed was searched using key words that included obsessive-compulsive disorder, geriatric, elderly, aging, and older. Of the 644 articles identified, we included 78 that were relevant to the topic. Articles that were excluded as irrelevant included studies that were not focused on OCD in older adults, animal studies, and older case reports if we identified similar more recent case reports. The literature contains very little information about the epidemiology, diagnosis, psychopathology, and treatment of OCD in older adul...
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

The Impact of Personality Pathology on Treatment Outcome in Late-life Panic Disorder
Conclusions: Cluster B pathology had a detrimental effect on CBT treatment outcome for panic disorder in both age groups. In late-life panic disorder with comorbid personality pathology, CBT may be preferred over treatment with paroxetine. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

Finding the Best Balance
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2020 Category: Psychiatry Tags: From the Editor Source Type: research

Acknowledgment of Peer Reviewers
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - March 1, 2020 Category: Psychiatry Tags: Acknowledgment of Peer Reviewers Source Type: research

Handbook of Mentalizing in Mental Health Practice, Second Edition
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - March 1, 2020 Category: Psychiatry Tags: Book Review Source Type: research

Documentation Practices for Transgender Youth Admitted to an Inpatient Psychiatric Unit
Conclusions: Findings from this study suggest that inpatient treatment teams show inconsistency in documentation practices for youth transgender inpatients. Further work is necessary to understand the implications of these findings for patient satisfaction and clinical outcomes. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - March 1, 2020 Category: Psychiatry Tags: Practitioner's Corner Source Type: research

Parent-led Behavioral Intervention for a Treatment-refusing Adult With Obsessive-Compulsive Disorder With Poor Insight and Extreme Family Accommodation
Obsessive-compulsive disorder (OCD) with poor insight can contribute to the refusal to receive treatment, leaving the burden of care on parents or other caregivers. The case presented here involved a young adult with OCD with delusional levels of insight paired with extreme family-accommodating behaviors that had resulted in impaired quality of life and functioning for the young adult and his parents. A parent-led behavioral intervention [The Supportive Parenting for Anxious Childhood Emotions (SPACE)] that was developed for children with anxiety was adapted and utilized for a young adult with severe OCD. The case presents...
Source: Journal of Psychiatric Practice - March 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Tianeptine Abuse Leading to an Episode of Psychosis: A Case Report and Literature Review
Tianeptine is an atypical mu-opioid receptor agonist. It is available as an antidepressant outside the United States, but it is also classified as a controlled substance in many other countries. It is not approved by the United States Food and Drug Administration for the treatment of depression but it can be obtained online without a prescription. The case described in this article involved a patient who developed symptoms of psychosis on supratherapeutic doses of tianeptine, highlighting the importance of inquiring into all supplements taken by patients when conducting an initial psychiatric evaluation. (Source: Journal o...
Source: Journal of Psychiatric Practice - March 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Blackout Versus Pass Out in Allegations of Alcohol-involved Sexual Assault: Why Knowing the Difference Matters
It is common for not only laypersons but also courts, witnesses, attorneys, and even some experts involved in a criminal sexual assault investigation to confuse the terms “blackout” and “pass out” when referring to the memory, consciousness, and other behavioral ramifications of alcohol intoxication. A typical alcohol-involved sexual assault allegation often includes the partial or total absence of memory for events of the alleged incident. The etiology and behavioral presentations of the types of alcohol-induced memory deficiency evidenced are not all created equal and understanding the differences...
Source: Journal of Psychiatric Practice - March 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

The Mental Health Crisis in America: Recognizing Problems; Working Toward Solutions: Part 2. Offering Hope Through Engagement
This column is the second in a series summarizing the 2-day Centennial Conference of the Austen Riggs Center. The conference framed problems in access to care and in the nature of the care being provided that are part of a mental health crisis in America, and then worked to propose solutions. This column addresses problems with the nature of care provided, proposing psychodynamic perspectives that offer hope through engagement. Such approaches play a role in “bending the curve” to improve mental health outcomes. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - March 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

Drug-Drug Interactions (DDIs) in Psychiatric Practice, Part 9: Interactions Mediated by Drug-metabolizing Cytochrome P450 Enzymes
This column is the ninth in a series exploring drug-drug interactions (DDIs) with a special emphasis on psychiatric medications. The first 3 columns in this DDI series discussed why patients being treated with psychiatric medications are at increased risk for taking multiple medications and thus experiencing DDIs, how to recognize such DDIs, strategies for avoiding and/or minimizing adverse outcomes from such DDIs, and pharmacokinetic considerations concerning DDIs in psychiatric practice. The fourth and fifth columns in this series presented a pair of parallel tables, one of which outlined the primary, known mechanism(s) ...
Source: Journal of Psychiatric Practice - March 1, 2020 Category: Psychiatry Tags: Columns Source Type: research

Group Intervention for Young Adults With Mood and Anxiety Disorders Transitioning to College
Young adults with chronic mood and anxiety disorders may receive a range of services in pediatric care (eg, psychiatry, therapy) and within the school system (eg, individualized education plans). Such services rely on the involvement of parents or guardians to support youth (eg, attending appointments, administering medications). However, in college, young adults are often on their own and need to assume responsibility for scheduling appointments, obtaining and taking medications, and seeking out additional services (eg, accommodations). Unfortunately, many young adults may not have developed the skills needed to navigate ...
Source: Journal of Psychiatric Practice - March 1, 2020 Category: Psychiatry Tags: Articles Source Type: research

Obsessive-Compulsive Symptoms in Obsessive-Compulsive Disorder and in Generalized Anxiety Disorder: Occurrence and Correlations
Conclusions: The study revealed that patients with GAD often have coexisting obsessive-compulsive symptoms, which may not be identified during routine psychiatric examination. Obsessive-compulsive symptoms observed in patients with GAD may show a different structure than obsessive-compulsive symptoms in patients with OCD. The results of this study suggest that compulsions are more specific for the diagnosis of OCD than obsessions. Compulsions, such as counting related to the need for order and symmetry, may be associated with some cognitive dysfunctions and male sex, a finding that requires further research. (Source: Jou...
Source: Journal of Psychiatric Practice - March 1, 2020 Category: Psychiatry Tags: Articles Source Type: research