Selective Serotonin Reuptake Inhibitors: How Long Is Long Enough?
Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications. They are among the first-line medications for several chronic or relapsing-remitting psychiatric conditions, including major depressive disorder and anxiety disorders. The advantages of SSRI use include ease of titration and their tolerability and safety profile. Guidelines for the short-term use of SSRIs are widely available, but there is no well-organized guidance on how and whether to maintain a patient on SSRIs for the long-term. In this article, we discuss the benefits and possible adverse consequences of long-term SSRI...
Source: Journal of Psychiatric Practice - September 1, 2021 Category: Psychiatry Tags: Articles Source Type: research
Predicting 30-Day Readmissions: Evidence From a Small Rural Psychiatric Hospital
To improve quality of care and patient outcomes, and to reduce costs, hospitals in the United States are trying to mitigate readmissions that are potentially avoidable. By identifying high-risk patients, hospitals may be able to proactively adapt treatment and discharge planning to reduce the likelihood of readmission. Our objective in this study was to derive and validate a predictive model of 30-day readmissions for a small rural psychiatric hospital in the northeast. However, this model can be adapted by other rural psychiatric hospitals—a context that has been understudied in the literature. Our sample consisted of 1...
Source: Journal of Psychiatric Practice - September 1, 2021 Category: Psychiatry Tags: Articles Source Type: research
Guest Editorial: Going Back to My Country
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - September 1, 2021 Category: Psychiatry Tags: From the Editor Source Type: research
Human Trafficking: A Treatment Guide for Mental Health Professionals
No abstract available (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Book Review Source Type: research
Commentary: Diagnostic and Treatment Issues in Psychosis
The 3 cases presented in this issue highlight challenges in evaluating and treating patients with psychotic symptoms. The first case involved the rare but debilitating condition of periodic catatonia, the second case involved the use of intranasal oxytocin to augment an antipsychotic for a patient with worsening psychotic symptoms (and a prior diagnosis of schizophrenia) in the postpartum period, and the third case involved auto-enucleation (often referred to as “Oedipism”), a violent form of self-mutilation, in a patient presenting with first-episode schizophrenia. These case reports reinforce the need to consider a w...
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Clinical Case Discussion Source Type: research
The Vision of Blindness—Sight Versus Insight: A Case Report and Literature Review of Self-enucleation (Oedipism)
We present a case of bilateral self-enucleation by a young male patient in the context of his first episode of psychosis and review the literature on this clinical entity. Ocular damage interferes significantly with activities of daily living and is associated with decreased quality of life so that identifying risk factors is of major importance to prevent this dangerous behavior. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Clinical Case Discussion Source Type: research
Add-on Oxytocin in the Treatment of Postpartum Acute Schizophrenia: A Case Report
An increasing body of research has been published concerning the potential impact of oxytocin (OT) in the pathophysiology of neuropsychiatric disorders that affect social functioning, such as schizophrenia. The possible therapeutic effect of OT in promoting mother-child bonding could be valuable in the management of postpartum psychosis. Studies on the efficacy of OT as an add-on therapy in the treatment of schizophrenia have found reductions in both positive and negative symptoms. The patient in the case reported here developed her second psychotic episode at the age of 22, a month after delivering her first child. Four w...
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Clinical Case Discussion Source Type: research
Periodic Catatonia: Long-term Treatment With Lamotrigine: A Case Report
Periodic catatonia is a rare form of catatonia, characterized by episodes occurring in a cyclic pattern with clinical features of combined stupor and excitement, with intervals of remission. Although periodic catatonia is not common, it is an urgent condition, requiring hospitalization for evaluation and treatment. The management of periodic catatonia is quite challenging, mainly because of the unknown pathophysiological mechanisms involved in the onset of this clinical entity, which are less clear than in other forms of catatonia. Although positive trials of several medications in the acute phase of periodic catatonia hav...
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Clinical Case Discussion Source Type: research
Treatment of Cannabinoid Hyperemesis With Olanzapine: A Case Series
The use and availability of cannabis for recreational and medical purposes has become more widespread with increased legalization. Adverse health outcomes of this increased use include cannabinoid hyperemesis syndrome (CHS), which is underrecognized in medical settings. Cessation of substance use is the recommendation of choice for the complete resolution of CHS. However, interventions that provide rapid relief may be necessary in treatment-refractory cases. Little evidence is available to guide care in these cases. Here we report 4 cases of treatment-refractory CHS, all of which remitted after treatment with olanzapine. O...
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Practitioner’s Corner Source Type: research
Evaluating a Multicomponent Strategy to Address Burnout, Job Engagement, and Job Satisfaction Among Telepsychiatrists
Conclusions:
Given the risk for social, professional, and academic isolation among telepsychiatrists, organizational engagement efforts are advisable, feasible, and may be associated with significant improvement in satisfaction and retention among telepsychiatrists. Our findings have important implications for enhancing the performance and job satisfaction of telepsychiatrists and potentially reducing burnout rates in this population of providers.
Practical Applications:
Effective strategy efforts included: (1) enhancing and standardizing recruitment efforts to ensure proper matching of the psychiatrist with org...
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Practitioner’s Corner Source Type: research
Therapeutic Risk Management for Violence: Safety Planning for Other-directed Violence
Therapeutic management of risk for other-directed violence (ODV) involves screening, assessment, and clinically appropriate intervention. In this 5-part series, effective screening and assessment for ODV have been described as a combination of clinical interviewing and the use of structured tools to inform clinical impressions of both acute and chronic risk for violence. Once risk of violence is identified, therapeutic management of the risk throughout the course of treatment is best achieved by determining the function of the violent ideation and behavior. This can be achieved through the use of functional chain analysis....
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Columns Source Type: research
Providing a Routine Medical Necessity Letter to Improve Access to Care for Our Patients
This column explains the value of developing routine medical necessity letters to help patients maximize the likelihood of securing insurance approval for medically necessary services for the treatment of mental and substance use disorders, including psychotherapeutic treatment. The structure proposed for such medical necessity letters is based on the terms of the Mental Health Parity and Addiction Equity Act and the landmark verdict in the federal class action known as Wit v. United Behavioral Health/Optum. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Columns Source Type: research
Charting and Handling Therapeutic Drug Monitoring Results: How they Differ From Most Laboratory Results
Therapeutic drug monitoring (TDM) results are a biological measure of the ability of the patient to clear a drug as long as the patient is adhering to the prescribed dosage. If the patient is not adherent, then TDM can provide evidence of such nonadherence. To properly interpret TDM results, several variables must be considered. First and foremost is the dose the patient is supposed to be taking. The second variable is whether the patient should have achieved a steady-state condition, which means that the amount of drug the patient is taking in a day is equal to the amount the patient is eliminating in the same day so that...
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Columns Source Type: research
Exercise Prescription Practices to Improve Mental Health
Conclusions:
Exercise is recognized by most clinicians as a therapeutic option for psychiatric conditions. Despite this recognition, only a small proportion provide recommendations consistent with national guidelines or empirical research. (Source: Journal of Psychiatric Practice)
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Resident Paper Winner Source Type: research
Can Nonoffending Pedophiles Be Reached for the Primary Prevention of Child Sexual Abuse by Addressing Nonoffending Individuals Who Are Attracted to Minors in the United States? New Strategies With The Global Prevention Project
This paper introduces a new prevention strategy against child sexual abuse (both offline and online) in the United States. The Global Prevention Project is a supportive treatment program designed for nonoffending minor-attracted persons who reside in the community. Attraction to minors and the underlying scientific terms (pedophilia/hebephilia) are discussed and a framework is provided for how to implement such a program in the United States. Our treatment modality is described to provide transparency in our clinical work. We discuss challenges encountered in this domain with possible solutions and the legal ramifications ...
Source: Journal of Psychiatric Practice - July 1, 2021 Category: Psychiatry Tags: Articles Source Type: research
