Journal of Psychiatric Practice最新文献

{"title":"Altered Mental Status Secondary to Clonidine Addiction and Withdrawal: A Cautionary Tale.","authors":"Brian Hodge, Samuel P Greenstein, Xavier Jimenez","doi":"10.1097/PRA.0000000000000900","DOIUrl":"10.1097/PRA.0000000000000900","url":null,"abstract":"<p><strong>Background and objectives: </strong>Clonidine is a commonly prescribed medication with various indications that has abuse potential. This brief report outlines a case of clonidine misuse that led to clonidine withdrawal.</p><p><strong>Methods: </strong>A 50-year-old male with a psychiatric history of Sedative-Hypnotic-Anxiolytic Use Disorder and Opioid Use Disorder in remission presented to the emergency department with a 1-day history of disorientation, slurred speech, word-finding difficulty, and altered mental status (AMS). Differential diagnoses included alcohol, benzodiazepine, and/or other substance intoxication versus withdrawal. The patient was placed on a lorazepam taper; however, his mental status worsened with further agitation, tachypnea, fever, tachycardia, hypertension, and myoclonus.</p><p><strong>Results: </strong>The patient was ultimately transferred to the intensive care unit, where he was placed on a dexmedetomidine infusion and steadily improved. Collateral information from the family revealed that the patient had been abusing clonidine. As the patient's mental status cleared, he too admitted to his clonidine addiction. During his admission, he was observed drinking large amounts of water and was also diagnosed with polygenic polydipsia. He was placed on fluid restriction, dexmedetomidine was eventually tapered, and he was ultimately discharged and referred to a dual diagnosis psychiatry unit for further treatment of his addiction.</p><p><strong>Discussion and conclusions: </strong>This case demonstrates the importance of understanding the multiple etiologies of AMS, including drug intoxication and withdrawal, particularly with commonly prescribed medications. Clonidine has abuse potential, and clonidine withdrawal must be considered in the differential diagnosis of a patient with a hypertensive crisis and AMS.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 1","pages":"40-42"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052752","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":"What Psychiatric Drug Development Can Learn From Cardiology Drug Development: Placebo Can Detect an Increase in the Mortality Rate. Part 3.","authors":"Sheldon H Preskorn","doi":"10.1097/PRA.0000000000000903","DOIUrl":"10.1097/PRA.0000000000000903","url":null,"abstract":"<p><p>This column, like the previous 2 columns in this series, shows how placebo is a control for the natural course of an illness. In the study presented in this column, the use of placebo enabled the investigators to detect that active treatment was deleterious to the patient. In the second column in the series, the use of placebo showed that adding a usually effective antibiotic for an infection did not alter the outcome because of the nature of the infection and the value of treatment as usual (TAU). The first column in the series described TAU in a double-blind randomized controlled trial (RCT). Parenthetically, that column also discussed how different TAU is in such studies versus TAU in clinical practice. Those differences likely contribute to why TAU in such trials can be quite effective and why they are frequently negative. That first paper also discussed how the Heisenberg Uncertainty Principle from physics can be applied to psychiatric clinical trials, further emphasizing the difference in care received in an RTC versus clinical practice. Thus, investigators need to take the Heisenberg Principle into account when designing their studies and readers need to consider it when assessing the results. In the studies described in the second and third columns in the series, the focus was on objective and clinically meaningful endpoints (ie, resolution of a localized infection in the second column and death in this third column) in contrast to the often subjective endpoints in many psychiatric clinical trials (eg, improvement on a rating scale of symptoms that are reported by a participant/patient). The field of psychiatry needs to aim to develop such objective and clinically meaningful endpoints for its clinical trials. Finally, all 3 columns in this series emphasize that placebo does not mean nothing but rather involves all the treatment that a patient receives during the trial, except for the investigational treatment being tested, as well as the natural history of the illness, which includes the natural fluctuation in symptoms.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 1","pages":"28-30"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052755","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":"Post-intensive Care Syndrome: Primer for the General Psychiatrist.","authors":"Emma R Torncello, O Joseph Bienvenu, George E Sayde, Ewa D Bieber, Jordan H Rosen, Joseph D Dragonetti","doi":"10.1097/PRA.0000000000000904","DOIUrl":"10.1097/PRA.0000000000000904","url":null,"abstract":"<p><p>As advances in critical care medicine improve survival outcomes, attention has been increasingly directed toward long-term management of patients recovering from critical illness. In 2010, the term \"post-intensive care syndrome\" (PICS) was proposed at a meeting of stakeholders at the Society of Critical Care Medicine's headquarters to highlight the physical, psychological, cognitive, and social impairments faced by many survivors of critical illness. PICS offers a holistic conceptualization of the long and challenging recovery process these patients may face in the months following a course of intensive care. In particular, psychiatric morbidity following critical illness is associated with worsened physical functioning, increased mortality, and lower quality of life. Thus, psychiatrists occupy a key role in the multidisciplinary management of PICS. This article provides a narrative review of the literature encompassing PICS, with a focus on post-intensive care psychiatric morbidity, to assist general psychiatrists and primary care clinicians in providing well-informed, comprehensive care to this patient population. Core aspects of psychiatric evaluation and management are reviewed, including the components of a comprehensive medical history, the use of screening instruments, pharmacologic and nonpharmacologic interventions, and the importance of a multidisciplinary, coordinated approach to care.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 1","pages":"22-27"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052769","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":"Handbook of Practical Psychopharmacology.","authors":"Ronald M Winchel","doi":"10.1097/PRA.0000000000000897","DOIUrl":"10.1097/PRA.0000000000000897","url":null,"abstract":"","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"32 1","pages":"43-44"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052758","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":"Collaborative Care in Perinatal Mental Health: Implementation and Insights From the UCLA MOMS Clinic.","authors":"Camila A Ferrario, Chelsea Shannon, Nataly Petrovic, Sarah Gray, Rachel Linonis, Rashmi Rao, Christina S Han, Deborah Krakow, Misty Richards","doi":"10.1097/PRA.0000000000000891","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000891","url":null,"abstract":"<p><p>Untreated peripartum psychiatric illness is a major public health concern, with significant effects for both pregnant women and their infants. Despite high levels of need, barriers to care continue to obstruct access for women in the preconception, pregnant, and postpartum periods. Evidence from randomized controlled trials suggests that perinatal collaborative care service models can improve access and reduce mental health burden for peripartum women with posttraumatic stress and depression. However, the literature describing the implementation of such programs outside of formal clinical trials is sparse. Here, we report on our service model at the Maternal Outpatient Mental Health Services (MOMS) clinic, a collaborative care clinic within the Obstetrics and Gynecology department. We describe how we implement the core, evidence-based pillars of our model, including (1) integration into primary care, (2) coordinated care support, (3) attention to the parent-infant relationship, (4) trauma-informed care, and (5) measurement-based care. We report on descriptive data at intake from 204 pregnant and postpartum women who presented to our clinic between August 2023 and June 2024. We conclude with a reflection on the successes and challenges of this model as well as a discussion about future directions for the clinic.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 6","pages":"312-318"},"PeriodicalIF":1.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654471","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":"Psychodynamic Therapy: An Overview for Trainees and Their Teachers: Part 3-Enactment, Interpretation, and \"Being With\".","authors":"Eric M Plakun","doi":"10.1097/PRA.0000000000000888","DOIUrl":"10.1097/PRA.0000000000000888","url":null,"abstract":"<p><p>This column completes a 3-part series offering an overview of psychodynamic therapy for trainees and their teachers seeking an accessible summary of key theoretical and technical elements. In a sense, this series is a quick start guide to psychodynamic therapy. This third column in the series summarizes the concept of projective identification, explains how projective identification contributes to the phenomenon of enactment, and addresses the importance of learning to detect, analyze, and utilize enactments. It also addresses the tension between making the unconscious conscious and \"being with\" patients in psychodynamic therapy. Finally, this column offers comments on how to put together and utilize all of the elements provided in this series.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 6","pages":"329-332"},"PeriodicalIF":1.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654408","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":"Evaluation of a Second-line Treatment in Female Adolescents With SSRI-nonresponsive Major Depression: A Real-world Data Analysis on Bupropion Versus Duloxetine.","authors":"Sina Ahmadifar, Mohaddese Shafiee Pour, Naeemeh Dini, Mohammad Reza Seddigh","doi":"10.1097/PRA.0000000000000894","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000894","url":null,"abstract":"<p><strong>Objective: </strong>A significant number of individuals with major depressive disorder (MDD) do not respond adequately to first-line treatment with selective serotonin reuptake inhibitors (SSRIs). Approximately 30% of patients fall into this category and often require a switch to a second-line antidepressant. These patients frequently experience more severe and persistent symptoms, along with an elevated risk of suicide. Switching to an alternative monotherapy such as duloxetine or bupropion is a common strategy in cases with inadequate response to SSRIs. Bupropion, in use for over 2 decades, works by inhibiting the reuptake of dopamine and norepinephrine and is sometimes used alongside SSRIs. Duloxetine, a serotonin-norepinephrine reuptake inhibitor, has demonstrated strong efficacy, safety, and tolerability in the treatment of MDD. However, antidepressants can occasionally increase suicidal thoughts or behaviors, particularly among adolescents. Therefore, the goal of this study was to compare not only the therapeutic outcomes of duloxetine and bupropion, but also the rates of any suicide attempts in female adolescents while taking these medications.</p><p><strong>Methods: </strong>This retrospective study analyzed medical records of 990 female adolescents diagnosed with MDD who were treated with either duloxetine (120 mg/d; n=464) or bupropion (300 mg/d; n=526). Patients were selected according to strict inclusion and exclusion criteria and followed for up to 24 weeks. Clinical data were extracted from charts at time points corresponding approximately to weeks 4, 8, 12, 16, 20, and 24. Depression severity and treatment outcomes were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) and Goal Attainment Scaling for Depression (GAS-D). The sensitivity of MADRS to symptom changes was also evaluated. Suicide attempts were identified using ICD-9 codes (E950 to E959), clinical notes, and related medication history involving SSRIs and serotonin-norepinephrine reuptake inhibitors.</p><p><strong>Results: </strong>The findings from the study revealed that bupropion led to a greater reduction in depressive symptoms compared with duloxetine. In addition, the incidence of suicide attempts was higher in the duloxetine group than in the bupropion group.</p><p><strong>Originality: </strong>This study is distinct in its focus on female adolescents with MDD, applying a triple-blind design and utilizing both standardized (MADRS) and personalized (GAS-D) outcome measures. By including an analysis of suicide attempt rates, it offers important clinical insights into the comparative effectiveness and safety of bupropion and duloxetine in a particularly vulnerable population.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 6","pages":"302-311"},"PeriodicalIF":1.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654449","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":"Clinically Distinguishing Bipolar Disorder From Other Psychiatric Conditions.","authors":"Samuel R Weber, Anne-Marie Duchemin","doi":"10.1097/PRA.0000000000000886","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000886","url":null,"abstract":"<p><p>Bipolar disorder is a severe mental illness, and rates of diagnosis have risen in recent years. Accurately diagnosing bipolar disorder can be difficult when a patient is not actively manic, as screening questionnaires are not reliable diagnostic tools, patient self-report can be unreliable, and bipolar symptoms overlap with other psychiatric conditions. Much has been written about the overlap between bipolar disorder and borderline personality disorder, but many other disorders present with similar symptoms, including unipolar depression. Accurate diagnosis is important to ensure optimal treatment and patient outcomes. The goal of this article is to provide an evidence-based approach to diagnosing bipolar disorder and distinguishing it from other psychiatric disorders in clinical settings. Using the mnemonic \"DIGFAST\" (distractibility, impulsivity, grandiosity, flight of ideas, activity increase, sleeplessness, talkativeness), we review the DSM-5-TR diagnostic criteria for mania. Distinguishing features include the episodic nature of elevated/irritable moods, severity of symptoms, and the simultaneous occurrence of multiple manic symptoms. Insight is typically impaired in bipolar disorder, and collateral information can help improve diagnostic clarity. Hypomanic symptoms can be distinguished from other conditions by their duration and accompanying changes in functioning. A thorough clinical interview is the most important asset in making an accurate diagnosis of bipolar disorder.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 6","pages":"319-326"},"PeriodicalIF":1.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654454","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":"Applying Motivational Interviewing Strategies to Facilitate Secure Firearm Storage During Clinical Encounters-Part 2: Technical Strategies.","authors":"Frances M Aunon, Steve Martino, Gabriela Khazanov, Suzanne E Decker, Steven Dobscha, Joseph A Simonetti","doi":"10.1097/PRA.0000000000000890","DOIUrl":"https://doi.org/10.1097/PRA.0000000000000890","url":null,"abstract":"<p><p>Motivational interviewing (MI) is an evidence-based clinical approach that aims to assist patients in navigating ambivalence and in building motivation and commitment for behavior change. MI may be an especially helpful approach in lethal means safety (LMS) counseling, given the challenges in encouraging patients to adopt new firearm storage practices. The purpose of this 2-part series is to demonstrate how MI strategies might be applied to evoke motivation to change firearm storage practices. This column builds on part 1 of this series, in which we provided a rationale for considering an MI-based approach and discussed how the relational foundation of MI may help facilitate LMS counseling. In part 2, we focus on the technical strategies we use to evoke motivation to change behavior (eg, language and tools), including the use of \"ask-offer-ask,\" recognizing and reflecting change talk, and using importance rulers.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 6","pages":"333-336"},"PeriodicalIF":1.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653679","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 Use of Nutritional Psychiatry in the Treatment of a Patient With Treatment-resistant Depression: A Biopsychosocial Case Report.","authors":"Victoria Hertl, Sonja Lackner, Anna Ramirez-Obermayer, Andreas Baranyi, Jolana Wagner-Skacel, Sabrina Mörkl","doi":"10.1097/PRA.0000000000000896","DOIUrl":"10.1097/PRA.0000000000000896","url":null,"abstract":"<p><p>This case study describes a 30-year-old patient with recurrent depressive disorder and pharmacological treatment resistance. After 2 courses of electroconvulsive therapy without significant improvement, the illness was classified as treatment-refractory. A comprehensive nutrient analysis and dietary history identified malnutrition, nutrient deficiencies, and gastrointestinal issues. By supplementing the treatment-as-usual approach with personalized nutritional and nutrient therapy, a significant reduction in depressive symptoms was achieved, and the pharmacological medication could be reduced. This case suggests that targeted nutritional and nutrient interventions may help enhance the effectiveness of pharmacological treatment and support mental health by promoting metabolic processes.</p>","PeriodicalId":16909,"journal":{"name":"Journal of Psychiatric Practice","volume":"31 6","pages":"337-345"},"PeriodicalIF":1.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654439","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}