Commentary on “A New Onset of Mania in a 49-Year-Old Man: An Interesting Case of Wilson Disease”
This report presents the case of a 49-year-old man with no formal psychiatric history who presented with a new onset of mania. We outline the distinctive characteristics that appeared inconsistent with a primary psychiatric disorder and pointed toward secondary mania. Despite low serum ceruloplasmin, the absence of brain abnormalities more typical of Wilson disease on magnetic resonance imaging led a neurology consultant to advise that the diagnosis was likely primarily psychiatric. Due to atypical components of the patient’s presentation, such as his late age of onset for bipolar disorder and acute cognitive decline, th...
Source: Journal of Psychiatric Practice - November 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research
A New Onset of Mania in a 49-Year-Old Man: An Interesting Case of Wilson Disease
This report presents the case of a 49-year-old man with no formal psychiatric history who presented with a new onset of mania. We outline the distinctive characteristics that appeared inconsistent with a primary psychiatric disorder and pointed toward secondary mania. Despite low serum ceruloplasmin, the absence of brain abnormalities more typical of Wilson disease on magnetic resonance imaging led a neurology consultant to advise that the diagnosis was likely primarily psychiatric. Due to atypical components of the patient’s presentation, such as his late age of onset for bipolar disorder and acute cognitive decline, th...
Source: Journal of Psychiatric Practice - November 1, 2020 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research
Therapeutic Risk Management for Violence: Stratifying Risk and Characterizing Violence
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 - November 1, 2020 Category: Psychiatry Tags: Columns Source Type: research
Trends in Psychiatric Residency Education and Practice From 1944 to 2019: A Loving, Informal, and Highly Personal Review Served With Gently Roasted Sacred Cow
In celebration of the American Psychiatric Association’s 175th anniversary, the author presents an overview of major trends in psychiatric residency education over the past 75 years, from 1944 to 2019, using narrative review and personal perspectives infused with occasional irreverence. In both 1944 and today in 2020, psychiatric educators have been challenged by having too many patients, too few clinicians, too few teachers, and too little knowledge. Over the course of these years, psychiatric residency training has adapted and evolved in response to major ongoing shifts in psychiatric practice patterns shaped by econom...
Source: Journal of Psychiatric Practice - November 1, 2020 Category: Psychiatry Tags: Columns Source Type: research
Why Are Patients With COVID-19 at Risk for Drug-Drug Interactions?
The goal of this column is to provide information to health care professionals about drug-drug interactions (DDIs) and why DDIs are important to consider in those at serious risk of illness with Coronavirus Disease 2019 (COVID-19). Important considerations discussed in this column include the frequency and complexity of multiple medication use, particularly important for the older patient who often has multiple comorbid illnesses. The column covers the following issues: (1) Why patients at high risk for serious illness from COVID-19 are also at high risk for DDIs. (2) Application of results of pharmacoepidemiological studi...
Source: Journal of Psychiatric Practice - November 1, 2020 Category: Psychiatry Tags: Columns Source Type: research
Personality Functioning in Obesity and Binge Eating Disorder: Combining a Psychodynamic and Trait Perspective
Conclusions:
Obese patients with BED or subthreshold BED had specific impairments in personality traits and personality functioning. Combined assessment indicated that patients with BED had the most vulnerable personality profile of the 4 groups. The results support the added value of assessment of both personality traits and psychodynamic personality functioning, in line with the alternative Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) model for personality disorders. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - November 1, 2020 Category: Psychiatry Tags: Articles Source Type: research
Outcome of First-admission Depression Treated in a Specialized Mood Disorders Service
This study describes the treatment and medium-term outcomes of a cohort of first-admission depressed patients with less treatment-resistant illness treated in a specialized MDU.
Methods:
A cohort of 137 consecutive first-admission depressed patients, referred to an MDU over 2 years, were interviewed using standardized schedules and followed up prospectively from admission for ∼18 months to describe baseline characteristics, treatment, outcome, and predictors of outcome. Times to recovery and recurrence were evaluated using survival analyses and predictors of outcome were examined using bivariate and multivariate r...
Source: Journal of Psychiatric Practice - November 1, 2020 Category: Psychiatry Tags: Articles Source Type: research
Exercise as Treatment for Youth With Major Depression: The Healthy Body Healthy Mind Feasibility Study
The goals of this study were to determine the feasibility of engaging youth with major depressive disorder (MDD) in a multimodal exercise intervention (Healthy Body Healthy Mind) plus usual care and to evaluate the magnitude of its effects on psychological, physical fitness, and biomarker outcomes to inform a future randomized controlled trial. Youth (15 to 25 y of age) with MDD diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) were eligible to participate. Feasibility measures included recruitment, retention, and program adherence rates. The exercise program consisted of a single ses...
Source: Journal of Psychiatric Practice - November 1, 2020 Category: Psychiatry Tags: Articles Source Type: research
The Relationship of Transcranial Magnetic Stimulation With Sleep and Plasticity
This article explores the interrelatedness of sleep, plasticity, and rTMS treatment. A PubMed-based literature review was conducted to identify all available studies examining the relationship of rTMS, plasticity, and sleep. Key words used in this search included “TMS,” “transcranial magnetic stimulation,” “plasticity,” “metaplasticity,” “sleep,” and “insomnia.” Depressed mood tends to be associated with impaired neural plasticity, while antidepressant treatments can augment neural plasticity. rTMS impacts plasticity, yielding long-lasting effects, with differing impacts on the waking and sleeping b...
Source: Journal of Psychiatric Practice - November 1, 2020 Category: Psychiatry Tags: Articles Source Type: research
TMS and Sleep
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - November 1, 2020 Category: Psychiatry Tags: From the Editor Source Type: research
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 were n...
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
