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Becoming Mindful: Integrating Mindfulness Into Your Psychiatric Practice
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: Book Review Source Type: research

Reward Dysfunction in the Manic Spectrum: Unable to Win? The Use of Biographical Information to Refine Neurobiological Modeling
Conclusions: The experience and neural correlates of hedonic processing may be impaired in the manic spectrum. Possible mechanisms for this impairment and its dissociation from the earlier stage of reward processing characterized by hyperactive reward pursuit are considered. Clinical reports and longitudinal, life-based follow-up can provide important data to supplement more experimentally based neurobiological models of reward dysfunction in bipolar disorders. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Voltage-gated Potassium Channel Antibody Autoimmune Encephalopathy Presenting With Isolated Psychosis in an Adolescent
Antibody-mediated encephalopathies associated with serum or cerebrospinal fluid antibodies directed against neuronal structures may present with a multitude of neuropsychiatric syndromes. Although some of the antibody-driven conditions are now well recognized in adults (eg, N-methyl-D-aspartate receptor antibody encephalitis), the spectrum of neuropsychiatric manifestations in the pediatric population is less clear. Psychosis, confusion, catatonia, and additional behavioral changes, along with seizures, encephalopathy, and movement disorders, may be initial manifestations or concurrent features in all age groups. Psychosis...
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Why Suicide Risk Assessment Still Matters
Both public awareness of suicide and professional efforts directed at suicide prevention have increased considerably in recent years. Unfortunately, rates of death by suicide have remained relatively stable over the past decade despite these enhanced efforts. Some have argued that “suicide risk assessment doesn’t work” and have called into question the utility of devoting clinical time and energy to risk assessment. In this column, the authors first present an overview of the argument against suicide risk assessment and the data supporting that argument, followed by an alternate argument as to why suicide...
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: Columns Source Type: research

A “Trans-Dyadic” Perspective on the Goldwater Rule
The Goldwater Rule has been debated, redefined, and debated further since the election of Donald Trump as President of the United States. This column offers a perspective on the Goldwater Rule that moves beyond psychiatry’s current preoccupation with precision DSM-5 diagnosis of individuals, which ethically requires consent or other legal authorization for release of diagnostic information to others, and into the realm of leadership as seen through the “trans-dyadic” lens of psychoanalytic understanding of large group processes on a societal level. Concepts from large group psychology are introduced to il...
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: Columns Source Type: research

CNS Drug Development, Lessons Learned, Part 4: The Role of Brain Circuitry and Genes—Tasimelteon as an Example
This is the fourth in a series of columns discussing the rational and targeted development of drugs to affect specific central nervous system (CNS) circuits in specific ways based on knowledge gained by molecular biology and the human genome project. The first column in this series described 6 CNS drugs with novel mechanisms of action developed over the last 25 years. The second column discussed differences between syndromic diagnoses as exemplified by the third through the fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM III through DSM-5) and the new approach to psychiatric diagnoses champ...
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: Columns Source Type: research

Psychosis Risk Syndrome: What Now?
Conclusions: “Attenuated psychosis syndrome” is a clinically useful concept. It identifies help-seeking individuals with mental health problems who need an intervention and who, if no treatment strategy is proposed, present a higher likelihood of developing a psychosis spectrum disorder in the years following their first contact with a mental health facility. In parallel with the clinical utility of this concept, additional research focused on this group of patients is warranted to further understand the emerging phase of psychotic disorders and to develop effective and efficient evidence-based prevention strat...
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Cognitive Behavioral Therapy for Chronic Pain—One Therapeutic Approach for the Opioid Epidemic
Opioids are frequently prescribed for chronic pain. For the past 2 decades, long-term opioid analgesic therapy was considered the cornerstone of effective pain management for chronic nonmalignant conditions, despite a lack of documented effectiveness and safety, with the attendant risk of addiction, overdose, and death. Cognitive behavioral therapy (CBT) may be used effectively to treat chronic pain, either as a stand-alone treatment or with other nonopioid pharmacological treatments. CBT improves pain-related outcomes along with mobility, quality of life, and disability and mood outcomes. Compared with long-term use of op...
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Outcomes of Acute Partial Hospital Treatment: Comparison of Two Programs and a Waiting List Control
Conclusions: Across 2 different acute PHPs, significant reductions in symptom severity and improvements in elements of cognitive functioning were observed. Findings indicate that acute PHP treatment may produce moderate-sized treatment effects in a 1-week period that seem unrelated to specific psychotherapeutic methods. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Use of Rapid Response Teams in Psychiatry: Variables that Impact Safety
Conclusions: We propose the acronym SCHEME to refer to a tool that can be used to quickly and easily assess medical risk in prospective psychiatric inpatients at the time of admission, which can help reduce the use of RRTs and CTs. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Disasters
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - November 1, 2017 Category: Psychiatry Tags: From the Editor Source Type: research

Ordinarily Well: The Case for Antidepressants
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: Book Review Source Type: research

An Unusual Case of Acute Psychosis With Obsessive-Compulsive Features Following Arsenic Poisoning
In this report, we present the case of a patient who developed acute psychosis with hallucinations, disorganized thinking, and obsessive-compulsive symptoms following chronic occupational arsenic exposure. The patient was treated with the combination of an antipsychotic and an antidepressant and he responded well with significant improvement in both the acute psychosis and obsessive-compulsive symptoms. The authors concluded that patients can develop atypical symptoms, including acute psychosis, following arsenic poisoning. In the case described in this report, the patient also presented with a new onset of obsessive-compu...
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Neurobiological Mediators of Squalor-dwelling Behavior
Squalor-dwelling behavior has been characterized as living in conditions so unsanitary that feelings of revulsion are elicited among visitors. This behavior is commonly associated with an insensitivity to distress/disgust and a failure to understand the direness of one’s living situation, which leads to social isolation and impairment in quality of life. Etiologically, several associations have been described in the literature, including age-related decline, lower socioeconomic status, and rural dwelling status. Primary neuropsychiatric disorders, such as psychosis, alcoholism, dementia, personality disorders, develo...
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Contending With Preplanned Death: Questions for Clinicians
Conclusions: Considerations regarding preplanned deaths merit greater professional and public discussion. Many options exist for improving how professionals address the quality of human experiences surrounding death. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: Columns Source Type: research

Bias Toward Psychodynamic Therapy: Framing the Problem and Working Toward a Solution
Although psychodynamic therapy (PDT) is an evidence-based intervention for a broad spectrum of psychiatric conditions, there is often notable bias in the way PDT is depicted both in the popular media and in the scientific literature. This has contributed to a negative view of PDT, which hampers both patient access to this treatment and researcher access to funding for further research on PDT. The adverse effects of these distortions and biases are detrimental not only to PDT but also to the overall field of psychotherapy, raising questions about its credibility. Here we summarize current evidence for PDT, describe existing...
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: Columns Source Type: research

CNS Drug Development: Lessons Learned Part 3: Psychiatric and Central Nervous System Drugs Developed Over the Last Decade—Implications for the Field
This column reviews the divergence between the approach to drug development in infectious disease, oncology, and immunology versus psychiatry. Between 2009 and 2016, 254 new drugs were approved. Of those, only 9 were for a psychiatric indication; another 5 were labeled to treat central nervous system disorders that are not considered psychiatric per se but are frequently found in individuals with psychiatric illnesses (eg, substantial weight gain). There were 2 additional new products for psychiatric indications that involved either a combination product (Contrave) or a prodrug for the production of aripiprazole (Aristada)...
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: Columns Source Type: research

Predictors of Length of Stay in a Psychiatric Adolescent Treatment Program
Understanding predictors of adolescent inpatient length of stay (LOS) is important in informing treatment outcomes for this age group. The current literature on adolescent LOS remains limited and has been characterized by methodological limitations. In the study described here, we examined a wide range of predictors for LOS in a psychiatric unit for adolescents (N=285), including severity of disorder (previous hospitalizations, self-harm, cognitive impairment and thought disorder, severe depression, history of trauma), types of psychotropic medication, and diagnoses. Our results indicated that LOS is associated with predic...
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Major Depressive Disorder in Patients With Doctoral Degrees: Patient-reported Depressive Symptom Severity, Functioning, and Quality of Life Before and After Initial Treatment in the STAR*D Study
Conclusions: Findings from this study indicated that, following citalopram monotherapy, the participants in the DOCS group achieved greater reductions in depressive symptom severity (based on effect sizes) than the participants in the non-DOCS group. For both treatment groups, the findings also showed the positive effect that remission status from MDD can have on QOL and functioning. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Blister Packaging Medication Increases Treatment Adherence in Psychiatric Patients
Conclusions: Psychiatric patients adhere better to prescription medication regimens when receiving their medications in BP. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Patient-reported Outcomes in Practice: Clinicians’ Perspectives From an Inpatient Psychiatric Setting
The use of patient-reported outcomes (PROs) has become increasingly common. They have been used to assess quality of care and to support policy decisions, but the evidence concerning their utility to improve patient outcomes is inconsistent. A better understanding of clinicians’ experience with PROs has the potential to improve their effectiveness. This exploratory, quantitative, and qualitative study investigated the perspectives of clinicians (N=70) from multiple disciplines (psychiatrists, psychologists, social workers, and psychiatric nurses) on the utility of PROs in an inpatient psychiatric setting. During sche...
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Death with Dignity
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2017 Category: Psychiatry Tags: From the Editor Source Type: research

DBT Principles in Action: Acceptance, Change and Dialectics
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: Book Reviews Source Type: research

Transference-focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: Book Reviews Source Type: research

A Model for Incident Review Committees in Behavioral Health Settings
We present a model for an incident review committee that has been implemented in 2 large, academic acute care psychiatric hospitals. We believe the model not only permitted us to efficiently and effectively review untoward incidents, but that it also provided an approach to calibrating standards of care for the institution, engaging physicians in an interdisciplinary effort, promulgating a culture of quality review and improvement throughout the organization, promoting continuity and sustainability of the incident review process, and, most importantly, driving beneficial change in clinical practice. Demonstration of the ef...
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: Practitioner's Corner Source Type: research

Transgender Youth in the Inpatient Psychiatric Setting: A Literature Review and Case Report
Once considered pathological, transgenderism is now accepted as a variant of normal sexuality. As society has become more accepting of transgenderism, increasing numbers of transgender patients have begun to seek psychiatric care, and younger populations are embracing their gender differences. There is a paucity of literature on how best to serve transgender youth in psychiatric inpatient units. In this article, we share our experience and discuss the need for practical guidelines to help the inpatient psychiatrist navigate key topics related to this population. We then present a case report to illustrate several of these ...
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Clinical Barriers to Effective Treatment of Eating Disorders and Co-occurring Psychiatric Disorders in Transgendered Individuals
Eating disorders (EDs) are complex and difficult to treat illnesses that are often chronic and disabling on their own accord or due to comorbidity with other psychiatric conditions. Historically, EDs have been viewed as illnesses of heterosexual, affluent white females. This stereotype increases the likelihood that these disorders will be underrecognized in the lesbian, gay, bisexual, and transgender community, as well as in different gender, socioeconomic, and ethnic populations. Our case report illustrates the clinical difficulties of managing a patient who presented to inpatient treatment with complaints of depression a...
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Politics in the Consulting Room
The recent presidential campaign and election have had a strong impact on many patients and clinicians. This guest column and its introduction by Dr Eric Plakun, who edits the psychotherapy section of the journal, note the inevitability that we will all self-disclose, while describing some of the pros and cons and impacts of self-disclosure of a clinician’s political perspectives. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: Columns Source Type: research

Targets for the Treatment of Insomnia in Veterans With Serious Mental Illness
Conclusions: Similar to insomnia among individuals without SMI, insomnia in Veterans with SMI is associated with dysfunctional sleep-related behaviors and cognitions. Many of the Veterans also lacked access to settings and resources conducive to healthy sleep. Veterans with SMI should be regularly assessed for insomnia. Research is needed concerning optimal evidence-based insomnia interventions for addressing behaviors and cognitions in this population in the context of these challenges. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Characteristics of Patients Involved in Physical Assault in an Acute Inpatient Psychiatric Setting
Conclusions: Clinicians should take extra precautions for involuntarily admitted young patients with a history of substance use, as they are more likely to exhibit assaultive behavior. A diagnosis of schizophrenia spectrum disorder in itself is not significantly associated with assaultive behavior. Screening instruments such as the Dynamic Appraisal of Situational Aggression may be useful in assessing risk of assault. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

The Presence of Childhood Attention Deficit/Hyperactivity Disorder May Be Associated With Interpersonal Sensitivity in Patients With Social Anxiety Disorder
The goal of this study was to evaluate a possible association between childhood attention deficit/hyperactivity disorder (ADHD) and interpersonal sensitivity in patients with social anxiety disorder (SAD). The study involved 125 adult outpatients with a primary diagnosis of SAD. To evaluate childhood ADHD, the ADHD module of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) was used. Clinical and sociodemographic data were collected and clinical rating scales were completed. Mean total scores on the Interpersonal Sensitivity Measure were significantly hi...
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Therapists’ Metacognitive Monitoring of the Psychotherapeutic Process With Patients With Borderline Personality Disorder
Conclusions: Reflection on the psychotherapeutic process with patients with BPD induced in therapists a self-focused, emotionally intense linguistic style dominated by references to themselves and their experience of intense emotional states. These results suggest that, when describing their work with patients with BPD, therapists experience metacognitive challenges and mentalization processes that may parallel the challenges therapists face when thinking and working during the psychotherapy sessions themselves. The results underscore the important role of supervision in assisting therapists to organize their reflective pr...
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Incident Review
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2017 Category: Psychiatry Tags: From the Editor Source Type: research

The Psychoanalytic Model of the Mind
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Book Review Source Type: research

Impact of an Alcohol Withdrawal Treatment Pathway on Hospital Length of Stay: A Retrospective Observational Study Comparing Pre and Post Pathway Implementation
Conclusions: This study demonstrates the successful implementation of an alcohol withdrawal treatment pathway in a medical-surgical population hospitalized in a large tertiary care facility with significant impact on hospital LOS. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Synthetic Cannabinoids Use in Elderly Patients
We report two cases of elderly individuals who used synthetic cannabinoids and were admitted to a psychiatric hospital. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Overcoming Barriers to Initiating Medication-assisted Treatment for Heroin Use Disorder in a General Medical Hospital: A Case Report and Narrative Literature Review
In this report, we describe the case of a woman with heroin use disorder who was initiated on buprenorphine maintenance treatment while hospitalized for cardiac disease related to her intravenous heroin use. Barriers to initiating buprenorphine in this case included patient, practitioner, and organizational factors, and, ultimately, shared misperceptions about the feasibility of administering buprenorphine in a general medical hospital. These barriers were addressed, buprenorphine was initiated, and the patient demonstrated reduced craving, improved postoperative pain control, improved overall well-being, increased engagem...
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Performance Validity Testing in Neuropsychology: Methods for Measurement Development and Maximizing Diagnostic Accuracy
In the first column in this 2-part series, Performance Validity Testing in Neuropsychology: Scientific Basis and Clinical Application—A Brief Review, the authors introduced performance validity tests (PVTs) and their function, provided a justification for why they are necessary, traced their ongoing endorsement by neuropsychological organizations, and described how they are used and interpreted by ever increasing numbers of clinical neuropsychologists. To enhance readers’ understanding of these measures, this second column briefly describes common detection strategies used in PVTs as well as the typical methods...
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Columns Source Type: research

Making Psychotherapy Great Again?
Psychotherapy never stopped being as “great” as other treatments. This column explores the evidence base for both psychotherapy and medications, using depression as a specific example. The limitations are comparable for psychotherapy and medication, with much of the evidence based on small degrees of “statistically significant” rather than “clinically meaningful” change. Our field’s biomedical emphasis leads to a false assumption that most patients present with single disorders, when comorbidity is the rule rather than the exception. This false assumption contributes to limitations...
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Columns Source Type: research

Switching From the Oral to the Depot Formulation of a Medication: Clinically Relevant Pharmacokinetic Concepts and Considerations
This column presents principles that will aid the prescriber in transitioning patients from an oral to a depot antipsychotic medication. The column covers the differences in the pharmacokinetics of oral versus depot formulations that are critical in making a smooth transition. Also discussed are some of the reasons to use these medications, which, in the author’s opinion, are currently underutilized. This column focuses on the big picture and the fundamentals of oral versus depot formulations rather than comparing the relative merits or potential advantages of the various marketed depot formulations. (Source: Journal...
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Columns Source Type: research

The Role of Amantadine Withdrawal in 3 Cases of Treatment-Refractory Altered Mental Status
Amantadine, which was originally developed as an antiviral medication, functions as a dopamine agonist in the central nervous system and consequently is utilized in the treatment of Parkinson disease, drug-induced extrapyramidal reactions, and neuroleptic malignant syndrome. For reasons that are not entirely understood, abrupt changes in amantadine dosage can produce a severe withdrawal syndrome. Existing medical literature describes case reports of amantadine withdrawal leading to delirium, which at times has progressed to neuroleptic malignant syndrome. Amantadine withdrawal may be under-recognized by mental health clini...
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Winner of Resident Paper Competition 2016 Source Type: research

Calmer Life: A Hybrid Effectiveness-implementation Trial for Late-life Anxiety Conducted in Low-income, Mental Health-Underserved Communities
Conclusions: CL will offer valuable information to help expand the reach of anxiety treatment among minority seniors living in underserved neighborhoods. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Reevaluating Antidepressant Selection in Patients With Bruxism and Temporomandibular Joint Disorder
Temporomandibular joint disorder (TMD) is a broad pain disorder that refers to several conditions affecting the temporomandibular joint of the jaw and the muscles of mastication. As with most pain disorders, a high prevalence of depression and anxiety is associated with TMD. Research has shown that selective serotonin reuptake inhibitors (SSRIs), the first-line drug therapy for major depressive disorder, may not be suitable for TMD patients because SSRIs can induce teeth-grinding, otherwise known as bruxism. This is problematic because bruxism is believed to further exacerbate TMD. Therefore, the purpose of this literature...
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Use of Lithium in Severe Acute Manic Episodes: Retrospective Prescription Practice From a Tertiary Inpatient Unit
Conclusions: Clinicians attempted to maintain serum lithium levels above 0.60 mEq/L at the time of acute treatment initiation, consistent with established guidelines. Clinical practice in large inpatient settings may force clinicians to use lithium in combination with antipsychotics for the treatment of acute mania; the delayed action of lithium and the need for rapid stabilization may drive these practices. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: Articles Source Type: research

Late Life
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2017 Category: Psychiatry Tags: From the Editor Source Type: research

Acknowledgement of Peer Reviewers
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - March 1, 2017 Category: Psychiatry Tags: Book Reviews Source Type: research