Case Report: De Novo and Persistent Psychosis After Withdrawal From Chronic Opioid Therapy
We report a unique case of a de novo and persistent psychotic disorder after complicated opioid withdrawal in a patient without any psychiatric history. The patient developed persistent auditory hallucinations after discontinuation of chronic opioid therapy that responded only to atypical antipsychotic (olanzapine) treatment. This case illustrates the neuropsychiatric effects of chronic opioid exposure, as well as layered clinical management dimensions related to opioid detoxification and psychosis treatment. Long-term opioid therapy may have lasting neuropsychiatric effects, including playing a role in the development and...
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research
Two Cases Comparing the Presentations and Outcomes of Heroin-induced Toxic Leukoencephalopathy
We report 2 cases of heroin-induced TLE associated with noninhaled routes of administration and a well-documented history of opioid use disorder. The patient in the first case presented with moderate to severe symptoms. Magnetic resonance imaging of the brain revealed increased T2 and fluid-attenuated inversion recovery signals bilaterally throughout subcortical and periventricular white matter. She survived with significant cognitive issues at discharge from which she adequately recovered by 11-month follow up. The patient in the second case presented with severe symptoms. Magnetic resonance imaging of the brain showed di...
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research
Acute Onset Psychosis With Mystical Delusions in a Young Male Patient Following Discontinuation of Corticosteroid Therapy: A Case Report
In conclusion, our findings are suggestive of a potential role played by corticosteroids in the development of psychotic symptoms, for which routine screening protocols and therapeutic guidelines are still lacking. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research
Learning the “Science of the Art of Prescribing”: From Evidence-based Algorithms to Individualized Medicine in Psychiatric Care
The purpose of this review is to highlight the limitations of the traditional diagnosis/evidence-based symptom reduction paradigm and advocate for an individualized medicine approach that incorporates psychological and relational aspects of prescribing in addition to the objective patient presentation. Potential barriers, challenges, and proposed future directions for improving education in psychological and relational aspects of prescribing are discussed. Psychological aspects of prescribing, as recently spelled out in the field of psychodynamic psychopharmacology, are generally acknowledged as important, but they do not ...
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Practitioner's Corner Source Type: research
Implementation of a Hospital-based Brexanolone Program
Postpartum depression (PPD) is a serious complication of childbearing affecting ∼1 in 7 mothers. Left unrecognized and untreated, it is associated with negative outcomes for mothers and their infants. Building upon research suggesting that, for some women, hormonal fluctuations after childbirth contribute to the onset of depression, clinical trials have found promise in a novel treatment approach, brexanolone infusion. In 2019, the Food and Drug Administration (FDA) approved brexanolone as the first medication with an indication specifically for PPD. Delivering brexanolone treatment to patients in need requires overcomin...
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Practitioner's Corner Source Type: research
Forensic Mental Health Assessment as a Critical Intercept for Enhancing Mental Health Care
We present 2 case vignettes to illustrate the utility of FMHA for enhancing service delivery. Finally, we conclude by noting challenges to integrating FMHA into conceptualization and necessary next steps in research and programing. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Columns Source Type: research
Building a Comprehensive Biopsychosocial Database to Identify Underlying Causes of Suicide and Improve Suicide Prevention
In June, 2022, the United States Department of Veterans Affairs (VA) announced an initiative to reduce death due to suicide in US Veterans. This column is based on a proposal written for that initiative, as well as on an earlier psychopharmacology column in this journal that reviewed the statistics and the genetics of suicide, and the US medicolegal death investigation system. This system is composed of 3137 county coroner or medical examiner offices across the country that are responsible under state and local law for investigating deaths that are not explained by natural causes and are suspicious and/or unattended. Thus,...
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Columns Source Type: research
Emotion Regulation Mediates the Relationship Between Therapeutic Alliance and Anxiety in Emerging Adults During Inpatient Psychiatric Treatment
This study analyzed therapeutic alliance with the clinical team and change in anxiety symptoms in emerging adult psychiatric inpatients with the goal of establishing whether emotion regulation could serve as a mediator between these 2 constructs. Participants were 913 emerging adults (46.7% female; 18 to 25 y of age) who were voluntarily admitted to an intermediate length-of-stay (6 to 8 wk) inpatient psychiatric hospital. Each patient completed measures assessing anxiety symptoms, emotion regulation strategies, and working alliance as an assessment of therapeutic alliance. The results indicated that working alliance had...
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Articles Source Type: research
The Effect of Adjunctive Probiotics on Markers of Inflammation and Oxidative Stress in Bipolar Disorder: A Double-blind, Randomized, Controlled Trial
Conclusions:
This study did not find any significant or conclusive effects of probiotics supplementation on markers of inflammation and oxidative stress in patients with BD. Further studies are needed before a conclusion can be drawn about the efficacy of probiotics in the management of BD. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Articles Source Type: research
Quality of Life Among Geriatric Community Members Following the Kaohsiung Gas Explosion: A 5-Year Cross-Sectional Study
Conclusions:
While participants’ psychiatric status had improved after 5 years, their QoL continued to be affected, especially in those with stress and physical illness. The elderly groups maintained a relatively acceptable QoL in terms of psychological aspects. Postdisaster treatment and follow-up should be addressed to a greater degree, especially in victims with mental illness or chronic illness and those with fewer socioeconomic resources. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Articles Source Type: research
Posttraumatic Stress Disorder Among Health Care Workers During the COVID-19 Pandemic
Background:
Coronavirus disease 2019 (COVID-19) has taken a significant toll on people worldwide, and in particular, on the health care workers (HCWs) who have worked on the frontlines in the fight against the pandemic. The goal of this study was to investigate the prevalence of posttraumatic stress disorder (PTSD) and related factors in HCWs in the era of COVID-19.
Methods:
This cross-sectional survey study was conducted between September 15, and October 15, 2020, among HCWs in Turkey. The survey consisted of self-administered questionnaires, which included questions about sociodemographic variables, experience...
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: Articles Source Type: research
The Therapeutic Alliance
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2022 Category: Psychiatry Tags: From the Editor Source Type: research
Nature and Nurture in Mental Disorders: A Gene-Environmental Model, Second Edition
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Book Review Source Type: research
Commentary: Futility in Psychiatry
While other medical professions have grappled with end-of-life care, the areas of palliative psychiatry, and more particularly, futility in psychiatry, have not been thoroughly addressed. The 3 cases presented in this issue illustrate how patients can succumb to a medical condition while presenting with primary psychosis (a patient with treatment-resistant schizophrenia who starves himself), secondary psychosis (a patient with small cell cancer of the lung who develops psychotic symptoms in the context of a paraneoplastic neurological syndrome), or a factitious disorder (a patient with self-induced aplastic anemia from ing...
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research
Psychiatric Futility and Palliative Care for a Patient With Clozapine-resistant Schizophrenia
We present a case of a man who suffered from clozapine-resistant schizophrenia. His illness was characterized by prominent religious delusions and severe self-starvation. Neither the intensity of his symptoms nor his quality of life improved with available psychiatric interventions, and he experienced significant iatrogenic harms from enforced treatments. Recognizing clinical futility, in collaboration with a diverse multidisciplinary team, and making a clear shift to a patient-centered palliative approach allowed the patient’s treatment team to prioritize his autonomy and subjective meaning in his final months. Such app...
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research
