Journal of Psychiatric Practice最新文献

{"title":"The 16-Minute Hour: Combining Abbreviated Psychotherapy With Medication Visits. Part 3: Psychodynamic Therapy.","authors":"David Mintz, Samuel Dotson, John C Markowitz, Michael E Thase","doi":"10.1097/PRA.0000000000000862","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000862","url":null,"abstract":"<p><p>Psychiatrists increasingly practice psychotherapy by integrating their therapeutic training into brief medication visits. Insurance companies reimburse this approach using the 90833 Current Procedural Terminology (CPT) code, which corresponds to 16 to 37 minutes of add-on psychotherapy combined with pharmacotherapy. As scholarship focused on such short-form combined therapy is scarce, this 4-part series addresses the practice gap, providing guidance to practicing professionals. This installment addresses psychodynamic psychotherapy, a deeply personalized intervention that is increasingly recognized as a modality well suited to integration with psychopharmacology.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 4","pages":"217-221"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morgellons Disease as a Delusional Parasitosis: A Case Presenting with Dermatological and Ocular Symptoms.","authors":"Gonca Dokuz, Andaç Salman, Neşe Yorguner","doi":"10.1097/PRA.0000000000000872","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000872","url":null,"abstract":"<p><p>Morgellons disease is a rare and controversial disorder characterized by the perception of fiber-like structures in the skin and bodily sensations such as itching and crawling due to them. Patients may cause wounds by trying to remove nonexisting objects they sense. Some practitioners suggest that the disease may be associated with infectious pathogens. However, most clinicians and studies support the hypothesis that the disease is a form of delusional parasitosis. Patients with Morgellons disease, similar to those with delusional parasitosis, have fixed beliefs about foreign bodies on their skin and lack insight into their disease. Morgellons disease has predominantly been described in the dermatology literature, while it has received limited attention in the psychiatry literature. We report the case of a female patient who reported complaints of \"hairy, wire-like\" structures that appeared with sweat on her body. This patient was referred to psychiatry after initially presenting to the dermatology and ophthalmology clinics. The patient was diagnosed with Morgellons disease and treated with olanzapine. Morgellons disease is considered a form of delusional parasitosis; however, it is not recognized enough by psychiatrists due to the fact that patients mostly present at nonpsychiatric clinics. Therefore, the goal of this report is to increase awareness about Morgellons disease among clinicians, particularly psychiatrists.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 4","pages":"227-229"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acknowledgment of Peer Reviewers.","authors":"","doi":"10.1097/PRA.0000000000000867","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000867","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 4","pages":"235"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Hidden Epidemic: Suicide in the Elderly and How We Can Help.","authors":"Lia Jessica, Erikavitri Yulianti","doi":"10.1097/PRA.0000000000000871","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000871","url":null,"abstract":"<p><p>Suicide among older adults is a critical yet often overlooked public health concern, with this population exhibiting the highest suicide rates globally. This article explores the multifaceted factors contributing to suicide in older adults, including depression, loneliness, chronic illness, financial stress, and a loss of purpose. It also addresses challenges in identifying and preventing suicide, such as stigma, limited access to mental health services, and misclassification of cases. Current prevention strategies, including screening tools like the Geriatric Depression Scale, integrated care models, and community-based interventions, are discussed alongside ethical debates surrounding autonomy in end-of-life decisions. The article highlights critical research gaps in understanding how various social, cultural, and economic factors intersect to influence suicide risk in older adults. It underscores the need for longitudinal studies and culturally tailored interventions, particularly leveraging telehealth solutions to improve access to care. Recommendations for primary care physicians include enhancing suicide risk screening, fostering collaboration with mental health specialists, and leveraging community resources to reduce isolation. By adopting a comprehensive and collaborative approach, health care providers, researchers, and policymakers can address the unique needs of this vulnerable population and work toward reducing suicide rates among older adults.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 4","pages":"209-213"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medium-term Effects of Intensified Inpatient Dialectical Behavior Therapy on Psychosocial Outcomes.","authors":"David Mikusky, Niklas Sanhüter, Julia Bauer, Ana Macchia, Sandra Nickel, Birgit Abler","doi":"10.1097/PRA.0000000000000864","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000864","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates the medium-term effects of an intensified inpatient dialectical behavior therapy (DBT) program on psychosocial outcomes and predictors of response in patients with borderline personality disorder (BPD). While the effectiveness of DBT is well established, insights into psychosocial outcomes after inpatient treatment remain limited.</p><p><strong>Methods: </strong>All 115 patients with BPD who participated in an 8-week inpatient DBT program at a university hospital in southern Germany in 2021 and 2022 were evaluated. Psychopathological changes were assessed using the short version of the Borderline Symptom List (BSL-23). Sociodemographic data and data on psychosocial functioning were collected using questions from the Indications of Rehabilitation Status Score (IRES-3) questionnaire before treatment, as well as at a 6-month follow-up. BSL-23 data were also assessed after treatment. To examine predictors of response to therapy, categorical pre-post comparisons as suggested by Jacobson and colleagues were applied to the BSL-23.</p><p><strong>Results: </strong>Eighty percent of the patients (n=92) completed the therapy. The patients who completed therapy were older than the dropouts. Significant reductions in BPD symptoms (BSL-23) were observed posttreatment (n=83) and at the 6-month follow-up (n=35). Effect sizes were large posttherapy (Cohen's d=0.837) and remained moderate after 6 months (d=0.460). With regard to psychosocial functioning, patients reported increased social support, fewer concerns about social relationships, and higher life and job satisfaction 6 months after therapy. Higher educational attainment was a significant predictor of treatment response.</p><p><strong>Conclusions: </strong>The intensified inpatient DBT program described in this article led to significant and sustained reductions in symptoms and improvements in psychosocial outcomes in patients with BPD. Educational levels and age at treatment onset may be critical factors for successful treatment.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 4","pages":"184-191"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health, Racism, and Contemporary Challenges of Being Black in America.","authors":"Michael McClam","doi":"10.1097/PRA.0000000000000866","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000866","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 4","pages":"234"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sixteen Minutes.","authors":"John M Oldham","doi":"10.1097/PRA.0000000000000870","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000870","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 4","pages":"183"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Depression and Anxiety Self-report Inventory Cutoffs to Screen for Invalid Psychiatric Symptom Overreporting During Diagnostic Evaluations for Attention-deficit/Hyperactivity Disorder.","authors":"Jason R Soble, John-Christopher A Finley, Matthew S Phillips, Steven A Abalos, Victor A Valencia, Kyle J Jennette, Neil H Pliskin","doi":"10.1097/PRA.0000000000000865","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000865","url":null,"abstract":"<p><strong>Objective: </strong>This study validated embedded symptom validity tests (SVT) in the Beck Depression (BDI-II) and Beck Anxiety (BAI) Inventories that are sensitive to psychiatric symptom overreporting in an outpatient clinical population referred for attention-deficit/hyperactivity disorder diagnostic evaluation.</p><p><strong>Methods: </strong>Cross-sectional data from 623 consecutive neuropsychological referrals were analyzed. The sample comprised young-to-middle-aged community-dwelling adults, was predominantly female (61%), and 44% non-Hispanic white, 25% Hispanic, 16% non-Hispanic black, 10% Asian, and 5% other race/ethnicity.</p><p><strong>Results: </strong>BDI-II ≥ 26 (33% to 86% sensitivity/90% specificity) and BAI ≥ 16 (38% to 82% sensitivity/90% specificity) were optimal cut-scores for detecting potential symptom overreporting. Scores exceeding the cutoffs on both the BDI-II and BAI SVTs should be counted as a single elevation, because these tests captured redundant aspects of overreporting. However, the BDI-II SVT was the stronger symptom overreporting indicator and should be prioritized as the more accurate test when BDI-II/BAI SVT discrepancies occur.</p><p><strong>Conclusions: </strong>BDI-II and BAI embedded SVTs can detect possible symptom overreporting among diagnostically diverse outpatients undergoing attention-deficit/hyperactivity disorder evaluations. These SVTs are not intended to replace well-validated SVTs, but screen for symptom overreporting and identify patients who may require further assessment without incurring additional time, costs, or burden, as they are embedded in brief, routinely administered self-report measures.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 4","pages":"201-208"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrave, Lybalvi, Auvelity, and Cobenfy: What Do They Have in Common?","authors":"Sheldon H Preskorn","doi":"10.1097/PRA.0000000000000863","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000863","url":null,"abstract":"<p><p>This column reviews 4 psychiatric combination products: Contrave (bupropion + naltrexone), Lybalvi (olanzapine + samidorphan), Auvelity (dextromethorphan + bupropion), and Cobenfy (xanomeline + trospium). All have been approved in the last 11 years. These medications are all based on planned and therapeutic drug interactions involving pharmacokinetics and/or pharmacodynamics. In each case, the second drug in the combination enhances the efficacy and/or reduces the adverse effects of the first drug. This review illustrates how basic science in pharmacokinetics and brain circuitry was fundamental to the development of these products, particularly in the case of Contrave and Cobenfy.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 4","pages":"214-216"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mood Stabilizers, Antipsychotics, and Electroconvulsive Therapy in Patients With Bipolar Disorder During Pregnancy and Postpartum: A Narrative Review.","authors":"Amaury Cantilino, Aldo Vilar","doi":"10.1097/PRA.0000000000000868","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000868","url":null,"abstract":"<p><strong>Objective: </strong>Women with bipolar disorder are at higher risk of complications during pregnancy, which may be associated with risky behaviors by the mother during acute episodes, as well as pharmacotherapy's inherent risks to mother and/or infant. The goal of this narrative review is to discuss the treatment of bipolar disorder during pregnancy and breastfeeding.</p><p><strong>Methods: </strong>A literature search was conducted between October 2023 and July 2024 using the PubMed database, with MeSH terms \"bipolar disorder\" and \"pregnancy\" combined with the Boolean operator \"AND.\" Publications from 2014 to 2024 were considered, resulting in the identification of 573 articles. After titles were reviewed, 84 papers were selected for full-text review, 33 of which were included in the study.</p><p><strong>Results: </strong>Cardiopathies associated with lithium use during pregnancy in infants were reported in the 1970s, but more recent case-control and cohort studies have shown that this risk is much lower than was previously reported. However, maintaining lithium levels during pregnancy can be challenging due to physiological adaptations in renal function. Valproate exposure has been found to be associated with increased risk of neural tube defects, craniofacial, cardiac, genital, and musculoskeletal abnormalities in infants. There does not appear to be an increased risk of malformations associated with lamotrigine, and results of studies diverge concerning carbamazepine and oxcarbazepine. No statistically significant association has been reported concerning the risk of congenital malformations and prenatal exposure to antipsychotics as a group, as well as for the subgroup of atypical antipsychotics. However, it is possible that risperidone slightly increases the risk of cardiac malformations. Electroconvulsive therapy during pregnancy appears to be a relatively safe treatment; however, the small sample size reported in the literature limits more robust conclusions.</p><p><strong>Conclusions: </strong>Pharmacotherapy during pregnancy and lactation requires careful discussion and documentation so that the prescriber and the patient can be aware of its risks and benefits.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 4","pages":"192-200"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}