Journal of Psychiatric Practice最新文献

{"title":"Steroid-induced Obsessive-compulsive Disorder Associated With Oral Budesonide: Case Report and Literature Review.","authors":"Brody Montoya, Hayley Lazar, Kenneth Fleishman","doi":"10.1097/PRA.0000000000000847","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000847","url":null,"abstract":"<p><p>While psychiatric adverse effects to corticosteroids have been widely reported in the literature, only 6 reports of new-onset, steroid-induced obsessive-compulsive disorder (OCD) have been published. This article discusses what, to our knowledge, is the first reported case of oral budesonide-associated steroid-induced OCD. The patient was a 73-year-old female with a psychiatric history of bipolar disorder who developed pedophilic obsessive-compulsive symptoms as part of a constellation of psychiatric symptoms 14 days after starting oral budesonide 9 mg/d for the maintenance treatment of lymphocytic colitis. Following treatment recommendations for general psychiatric adverse effects to steroids, the patient was restarted on her original medications, tapered off budesonide over 14 days, and started on brexpiprazole 2 mg/d. The patient's symptoms fully resolved within 14 days of starting treatment. While this case demonstrates many risk factors for the general psychiatric adverse effects of steroids, there are notable differences between the characteristics shared by the reviewed cases of steroid-induced OCD and this case. This finding suggests that risk factors for steroid-induced OCD may vary from the general risk factors for psychiatric adverse effects and should be further researched. Despite some differences, both this case and previous cases in the literature demonstrated a resolution of OCD symptoms following discontinuation of the corticosteroid, adding evidence to current recommendations of discontinuing the corticosteroid, when possible, to treat steroid-induced psychiatric symptoms. Finally, despite a warning on the drug label concerning compulsive behaviors, augmentation with brexpiprazole was associated with a resolution of symptoms in this case. Brexpiprazole should be further researched for possible uses in both steroid-induced OCD and primary OCD.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 2","pages":"107-112"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752247","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":"Racial and Ethnic Considerations for the Clinical Practice of Psychopharmacology and Research Methodology: A Narrative Review of the Growing Body of Literature.","authors":"Andrew Toyin Olagunju, Jeffrey Wang, Bassey Edet, Obiora E Onwuameze, Matthew Macaluso","doi":"10.1097/PRA.0000000000000845","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000845","url":null,"abstract":"<p><strong>Background: </strong>Race and ethnicity are important but often underexamined factors in psychopharmacology research and clinical practice. This review summarizes key findings on ethnic and racial considerations for researchers, medical practitioners, and clinical psychopharmacologists. We hope it serves an important function in highlighting a critically important, yet still emerging issue to inform research and therapeutic use of psychotropics to improve their effectiveness.</p><p><strong>Methods: </strong>We queried major databases (PubMed, PsycInfo, Embase) using a search strategy that included MeSH (Medical Subject Headings) terms and conducted a snowball search to identify studies addressing ethnic or racial aspects of psychopharmacological practice. Findings were synthesized and presented in clinically applicable areas.</p><p><strong>Results: </strong>The clinically relevant ethnic and racial considerations identified in this review can be broadly categorized into the following areas: (1) variations in therapeutic and adverse dose-responses (eg, non-Whites attaining therapeutic and adverse effects at lower doses with certain medications); (2) interracial differences in prescription patterns of psychotropics, with lower prescription rates among under-represented minority groups and greater use of first-generation antipsychotics in African American populations; and (3) variations in attitudes toward psychopharmacotherapy. While differences in medication response can be partially explained by genetic variations in metabolism or receptor sensitivity, systemic racism and social determinants of health continue to have an influence.</p><p><strong>Conclusions: </strong>The evidence base for ethnic and racial considerations in psychopharmacology research and clinical practice continues to evolve with growing consideration for diversity and inclusivity in training, research, and clinical practice. This is critical to promoting equitable and effective care to a diverse population. Key questions are highlighted to draw attention to these critical needs.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 2","pages":"56-64"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753269","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":"Evaluative Research on Psychodynamic Therapy: Foundations and Recent Advances.","authors":"Fabian Guénolé","doi":"10.1097/PRA.0000000000000826","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000826","url":null,"abstract":"<p><p>Psychodynamic therapy (PDT), a technical adaptation of psychoanalysis, is one of the most widely practiced forms of psychotherapy, making evaluative research on it essential. Although research on PDT has been ongoing for several decades, theoretical and practical challenges initially hindered the adoption of evidence-based medicine standards in such research, a shift that has largely taken place over the past 20 years. This article reviews the evolution of evaluative research on PDT for mental disorders in adults, with a focus on those with complex conditions. Since the first prospective evaluative studies in the 1950s, an accumulating body of knowledge-including cohort studies, randomized controlled trials, and meta-analyses-has established PDT as an evidence-based treatment for common mental disorders such as depression, anxiety, somatic symptoms and related disorders, and personality disorders, as well as complex mental disorders involving combinations of these conditions. There is also evidence supporting PDT's usefulness in treating anorexia nervosa and opioid dependence, along with some findings suggesting its potential use for schizophrenia spectrum disorders, bulimia nervosa, and posttraumatic stress disorder. Recent studies indicate that PDT can serve as a personalized treatment, promoting deep and lasting psychopathological changes in patients with severe, complex, and chronic mental disorders, involving specific technical features and mechanisms of change. These findings support the inclusion of PDT in mental health care policies and training, while ongoing research continues to explore its optimal treatment parameters.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 1","pages":"27-34"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007113","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":"Navigating the Discussion of Mental Illness With Korean Americans.","authors":"Young Suk Moon, Yesie Yoon, Dae Sun Hwang, Thomas K Pak","doi":"10.1097/PRA.0000000000000830","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000830","url":null,"abstract":"<p><p>Korean Americans have one of the highest rates of depression of the Asian subgroups in the United States, and they have culture-related factors that affect their mental health. It is important for health care providers to understand the cultural considerations of Korean Americans to better address their mental health. This review article delves into the pertinent cultural practices of Korean Americans for navigating discussions of mental health. We note the cultural views, language barriers, historical traumas, and immigration challenges of Korean Americans, and we consider the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision's discussion of Koreans. We also include a table of Korean mental health terms with cultural significance and a list of online resources tailored for Korean Americans. In addition, we discuss the unique experiences of North Korean refugees that affect their mental health. Overall, this review informs health care providers about cultural considerations for navigating discussions of mental health with Korean Americans.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 1","pages":"8-12"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007151","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":"Is Charles Bonnet Syndrome a Harbinger of Neurocognitive Disorder With Lewy Bodies? A Clinical Conundrum.","authors":"Shalini Kumari, Santanu Nath, Venkata Lakshmi Narasimha","doi":"10.1097/PRA.0000000000000828","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000828","url":null,"abstract":"<p><p>Charles Bonnet syndrome (CBS) is a clinical condition in which patients with visual impairment experience visual hallucinations (VH) in the presence of clear consciousness. It typically occurs in elderly people and confuses clinicians with multiple differential diagnoses due to VH, which can be present in a variety of clinical conditions ranging from psychosis to neurocognitive disorders (eg, neurocognitive disorder with Lewy bodies). In the latter, the concomitant presence of cognitive decline and parkinsonism aids the diagnosis. Here we report the case of an elderly man with retinitis pigmentosa (and thus significant visual loss), who presented with VH, thus warranting a diagnosis of CBS, but who later also manifested a rapid onset cognitive decline and parkinsonism, which necessitated a new diagnosis of major neurocognitive disorder with Lewy bodies. This case prompted us to consider whether CBS is a harbinger of neurocognitive disorder with Lewy bodies or whether there is a clinical overlap between these 2 clinical constructs. This case report attempts to unravel this clinical conundrum.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 1","pages":"49-52"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007119","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":"Association of Lambert-Eaton Myasthenic Syndrome and First Episode Psychosis: A Case Report.","authors":"Carlos Siopa, Catarina Cordeiro, Bernardo Melo Moura","doi":"10.1097/PRA.0000000000000837","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000837","url":null,"abstract":"<p><p>Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune neuromuscular junction disorder characterized by proximal weakness, autonomic dysfunction, and areflexia associated with antibodies against voltage-gated calcium channels (VGCCs). Psychotic symptoms can occur in many autoimmune neurological disorders but they have rarely been observed in myasthenic syndromes. We report the case of a 21-year-old woman with primary autoimmune LEMS due to anti-VGCC antibodies subtype P/Q, who developed psychotic symptoms 3 years after the onset of motor symptoms. These symptoms decreased after every cycle of monthly intravenous immunoglobulin therapy. Different causes of reversible psychosis were excluded, such as autoimmune encephalitis. Due to a worsening of the patient's muscle strength, and the psychotic episodes, the patient received several treatments including an admission to a neurology unit. To our knowledge, this is the first described case of psychotic symptoms associated with LEMS. We speculate that VGCC antibodies could have a role in the development of mental symptoms, although additional hypotheses are also discussed.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 1","pages":"42-45"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007092","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":"The McLean Screening Instrument for Borderline Personality Disorder: A Review.","authors":"Farah Semaan, Paul E Croarkin","doi":"10.1097/PRA.0000000000000827","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000827","url":null,"abstract":"<p><p>Borderline personality disorder (BPD) poses significant challenges for early identification and diagnosis due to its intricate symptomatology that overlaps with other psychiatric illnesses. To address this challenge, the McLean Screening Instrument for BPD (MSI-BPD) was developed to identify individuals displaying potential BPD symptoms. This review aims to consolidate the current limited body of research on the MSI-BPD, delving into its origins, the rigor of its validation process, its practicality in clinical settings, and potential applications. By comprehensively examining these aspects, clinicians and researchers involved in BPD assessment and diagnosis can develop a deeper understanding of the instrument's utility. The MSI-BPD's development involved meticulous consideration of BPD diagnostic criteria, resulting in a tool tailored to effectively capture relevant symptoms. Validation studies have provided supportive evidence for its accuracy in identifying individuals at risk of BPD, thereby underlining its utility as a resource for early screening and intervention in clinical settings. However, it is essential to acknowledge that, while the MSI-BPD demonstrates satisfactory psychometric properties and utility as a screening tool for BPD, its diagnostic accuracy may vary across diverse populations. Consequently, clinicians and academics must judiciously consider sample characteristics and potential limitations when utilizing this instrument in both clinical and research contexts. Recognizing the advantages and potential applications of the MSI-BPD within a comprehensive approach to addressing BPD is important for professionals working in the field of BPD assessment and diagnosis. It is important to emphasize that the MSI-BPD is a screening tool and one data point in understanding patients presenting with complex symptomatology.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 1","pages":"20-23"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007247","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":"Insomnia in Patients With Substance Use Disorders: Assessment and Management.","authors":"Cris Hanacek, Julian Lane, Yi-Lang Tang","doi":"10.1097/PRA.0000000000000832","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000832","url":null,"abstract":"<p><p>Insomnia, characterized by difficulty initiating or maintaining sleep, or poor sleep quality, is highly prevalent among individuals with substance use disorders (SUDs). The relationship between the 2 conditions is often bidirectional. We reviewed the impact of various substances (alcohol, stimulants, opioids, and cannabis) on sleep architecture and their potential to contribute to insomnia. The role of insomnia as a risk factor for different SUDs is also explored. Assessment strategies for co-occurring insomnia and SUDs are discussed, emphasizing the importance of reassessment throughout various phases of substance use treatment. Evidence-based nonpharmacologic and pharmacologic interventions for managing insomnia in SUD patients are presented, highlighting the importance of tailoring treatment approaches to individual needs and substance-specific considerations. Assessment and management of comorbid insomnia and SUDs is crucial but can be difficult; however, studies have shown some benefits using nonpharmacologic and pharmacologic approaches.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 1","pages":"2-7"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007117","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":"DSM-5-TR Clinical Cases.","authors":"David A Kahn","doi":"10.1097/PRA.0000000000000833","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000833","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 1","pages":"53"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007101","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":"Licensure Actions Against Psychiatric Clinicians: A Cohort Analysis of National Practitioner Database Reports.","authors":"Akanksha Dadlani, Jeffrey A Mills, Jeffrey R Strawn","doi":"10.1097/PRA.0000000000000831","DOIUrl":"10.1097/PRA.0000000000000831","url":null,"abstract":"<p><strong>Objective: </strong>To examine trends and predictors of administrative actions against psychiatric clinicians' licenses between 2002 and 2022.</p><p><strong>Methods: </strong>Data from the National Practitioner Data Bank (NPDB) identified 6400 disciplinary actions against psychiatric clinicians' licenses. Linear trend models assessed the trends of disciplinary actions across mental/physical health, licensing/legal issues, and unprofessional conduct. A first-order autoregressive model with a time indicator interaction term evaluated structural breaks (ie, a sudden or gradual change in the characteristics of data in a time series). Predictors of claims were assessed using logistic regression.</p><p><strong>Results: </strong>Since 2002, disciplinary actions related to clinicians' mental/physical health (P=0.004) and licensure/legal issues (P=0.018) have decreased, while actions related to unprofessional conduct remained unchanged (P=0.358). Declines emerged in 2012 for mental/physical health (break coefficient -0.367; P=0.026) and in 2009 for unprofessional conduct (break coefficient -0.199; P=0.013). Clinicians facing disciplinary actions related to physical/mental health were significantly younger than those with legal/licensure issues (P<0.001). While the average age remained stable for mental/physical health-related actions, the average age increased for actions related to licensure/legal claims and unprofessional conduct.</p><p><strong>Conclusions: </strong>The decrease in disciplinary actions related to physical/mental health may reflect better access and acceptance of treatment of clinicians, while the reduction in licensure/legal actions may indicate policy shifts. Findings regarding age underscore the need for enhanced support for mid and late-career clinicians to promote lifelong learning and practice.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 1","pages":"35-41"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}