A Fatal Case of Factitious Aplastic Anemia
We report the case of a 26-year-old female who intentionally ingested busulfan, an oral chemotherapy agent, to induce severe aplastic anemia. The patient was initially thought to be suffering from idiopathic aplastic anemia, before clues suggesting the diagnosis of a factitious disorder were identified. The patient underwent a bone marrow transplant and ultimately died 5 weeks later following a lengthy admission to the intensive care unit. It is unclear whether confrontation about a patient’s self-induction of physical illness is beneficial in the treatment of patients with factitious disorder. Cases such as this pose su...
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Psychosis as Initial Presentation of Small Cell Lung Cancer: A Case Report
In this report, we present the case of a 62-year-old African American male with a medical history significant for sarcoidosis and adrenal insufficiency who presented with several months of altered mentation and aggressive behavior of unknown etiology. Extensive laboratory workup, including lumbar puncture and cerebrospinal fluid antibodies, did not reveal any significant findings. Imaging studies, including computed tomography of the chest, showed mediastinal adenopathy and densities suggestive of metastatic small cell carcinoma, which was later confirmed following bronchoscopy and lymph node biopsy. A PNS was suspected as...
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

The Impact of Gender-affirming Hormone Therapy on Anatomic Structures of the Brain Among Transgender Individuals
Despite the growing numbers of individuals who identify as transgender, this population continues to face worse mental health outcomes compared with the general population. Transgender individuals attempt suicide at a rate that is almost 9 times that of the general population. Few studies have reported on the positive effect of gender-affirming hormone therapy on mental health outcomes in transgender individuals. It is likely that this effect is due in part to the physiological responses that occur as a result of hormone therapy that mitigate incongruencies between one’s gender identity and assigned sex. To our knowledge...
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Practitioner's Corner Source Type: research

A Verdict Overturned: Are We at Our Wit’s End?
Despite the 2008 Mental Health Parity and Addiction Equity Act, access to psychotherapy through health insurance is quite limited. The 2019 landmark verdict in Wit v. United Behavioral Health offered hope of change. This column describes the recent overturning of the verdict in Wit v. United Behavioral Health, efforts by the Plaintiffs’ attorneys to pursue a review by the entire 29-member United States Court of Appeals for the Ninth Circuit of the puzzling decision apparently based on a misunderstanding of the arguments of the case, and steps forward to implement the mental health parity law. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Columns Source Type: research

Treatment of Agitation in Individuals With Bipolar Disorder or Schizophrenia: Lessons Learned for Clinical Psychiatry and Psychiatric Drug Development
Six lessons can be learned from the pivotal registration trials for sublingual dexmedetomidine (SLD) for the treatment of agitation in individuals with bipolar disorder or schizophrenia: (1) Knowing the function of a well-defined circuit in the brain, such as the locus coeruleus (LC), facilitates the development of central nervous system drugs. (2) Agitation can be conceptualized both clinically and physiologically. From both perspectives, agitation can present and escalate along a spectrum from mild, characterized as mainly hyperaroused (possibly only a subjective experience with no observable manifestations in its mildes...
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Columns Source Type: research

A Retrospective Study of the Adjunctive Use of Gabapentin With Benzodiazepines for the Treatment of Benzodiazepine Withdrawal
Benzodiazepine withdrawal is a widespread problem with potentially severe and deadly consequences. Currently, the only medications available for treating benzodiazepine withdrawal are short-acting and long-acting benzodiazepines. Identifying other drugs to help in treating benzodiazepine withdrawal is necessary. Gabapentin, an anxiolytic drug that is also used off-label to treat alcohol withdrawal, is a potential candidate for modulating benzodiazepine withdrawal. Using electronic records from a large inpatient psychiatric facility, a retrospective study of 172 patients presenting with benzodiazepine withdrawal was conduct...
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Resident Paper Winner Source Type: research

Optimizing Obsessive-Compulsive Symptom Measurement With the Yale-Brown Obsessive-Compulsive Scales—Second Edition
We present 3 case studies that demonstrate the enhanced ability of the Y-BOCS-II to: (1) detect fluctuations in symptom severity among extremely ill patients, (2) systematically incorporate avoidance variables for more accurate ratings, and (3) maintain strong convergence with the Y-BOCS in assessing patients presenting with mild to moderate symptoms. In addition, we outline how to obtain both Y-BOCS and Y-BOCS-II scores within 1 administration by adding Y-BOCS item 4 to the Y-BOCS-II assessment, then “back-coding” the Y-BOCS-II ratings to Y-BOCS ratings and using Y-BOCS item 4 in place of Y-BOCS-II item 2. The use of ...
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Articles Source Type: research

Judging Personality Disorder: A Systematic Review of Clinician Attitudes and Responses to Borderline Personality Disorder
Conclusions: Negative attitudes toward BPD continue to be a problem to differing degrees among clinical staff. Although this issue is most prominent among psychiatric nurses, the results of this review highlight evidence of negative attitudes across all mental health professions as well as potentially in professionals working in physical health settings. Various clinician-level factors may play a role in the development and maintenance of such attitudes. Greater exposure to patients with BPD and attendance at training programs have been found to be associated with improved attitudes. Professionals require regular train...
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: Articles Source Type: research

Gun Safety Revisited
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2022 Category: Psychiatry Tags: From the Editor Source Type: research

Commentary: Diagnostic Challenges
The 3 cases presented in this issue highlight diagnostic challenges in evaluating and treating patients with complicated presentations. The first case involved a man with mild neurocognitive disorder due to Alzheimer disease accompanied by depressive and anxiety symptoms and what appeared to be previously undiagnosed attention-deficit/hyperactivity disorder. The second case involved an unusual case of shared psychotic disorder involving a woman with a primary diagnosis of bipolar disorder and her husband with posttraumatic stress disorder. The third case involved a patient with a history of multiple diagnoses who presented...
Source: Journal of Psychiatric Practice - May 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

A Case Report of Scrupulosity Presenting as Catatonia in a Patient With Both OCD and OCPD
This report summarizes the characteristics of scrupulosity and discusses this potentially deceptive mimic of more commonly seen conditions. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - May 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Shared Psychotic Disorder Associated With Bipolar Disorder in the Primary Case in the Context of Opioid Misuse
We report the case of a married couple endorsing simultaneous psychosis, a form of SPD. The primary case (the wife) had a diagnosis of BD, without any history of psychotic episodes before the current episode, while the secondary case (the husband) had a diagnosis of posttraumatic stress disorder. Both individuals were misusing prescribed synthetic opioids, and their psychosis was most likely induced by a withdrawal state. Cases of SPD involving patients with BD have rarely been reported. Considering the high rates of dual diagnoses among patients with BD, clinicians should be aware of the risk of substance-induced psychosi...
Source: Journal of Psychiatric Practice - May 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Association Between Mild Neurocognitive Disorder Due to Alzheimer’s Disease and Possible Attention-deficit/Hyperactivity Disorder: A Case Report
Recent literature concerning attention-deficit/hyperactivity disorder (ADHD) underlines the persistence of this neurodevelopmental illness in older patients. Comorbidity with a neurodegenerative disease is thus possible. However, few studies have investigated this topic. To our knowledge, this is the first case report of such a possible association, which raises important questions about clinical presentation, symptoms, diagnosis, and treatment. A 72-year-old man, without any psychiatric history, presented with depression, subjective memory loss, and attention deficit and anxious symptoms, and was diagnosed with mild neuro...
Source: Journal of Psychiatric Practice - May 1, 2022 Category: Psychiatry Tags: Clinical Case Discussions Source Type: research

Stages of Psychotherapy for Trauma and Stress-related Disorders
Psychotherapy technique should change as the stages of treatment for stress response syndromes progress. A formulation helps clinicians determine what to do at each stage. This progression should allow for integration of modalities of therapy. Configurational analysis provides 4 categories for organizing clinical inferences. It begins with an assessment of key symptoms and then the states of mind in which the symptoms vary because of degrees of emotional regulation. Unresolved emotional topics that lead to symptoms are then addressed in stages of exploring the meaning of memories. Finally, the self and relational schemas t...
Source: Journal of Psychiatric Practice - May 1, 2022 Category: Psychiatry Tags: Practitioner's Corner Source Type: research

Firearm Injury Prevention and Extreme Risk Protection Orders
Extreme risk protection orders (ERPOs) represent a potential mechanism to facilitate firearm-related lethal means safety. ERPOs are a legal mechanism that enables law enforcement to temporarily remove firearms from, and prevent firearm purchase by, an individual who presents a significant danger to self or others, as determined by a court of law. While few jurisdictions currently allow mental health professionals to initiate ERPO petitions, it nonetheless seems important that clinicians be familiar with ERPOs, as clinicians may still serve an important role in disseminating information and facilitating judicious petitions....
Source: Journal of Psychiatric Practice - May 1, 2022 Category: Psychiatry Tags: Columns Source Type: research