Annals of Clinical Psychiatry最新文献

{"title":"Increased infection rates associated with second-generation antipsychotics.","authors":"Taelor T Lee, Megan E Durham, Daniel S Demick, Samuel B Reynolds, Rif S El-Mallakh","doi":"10.12788/acp.0017","DOIUrl":"https://doi.org/10.12788/acp.0017","url":null,"abstract":"TO THE EDITOR: The use second-generation antipsychotic (SGA) medications is increasing for both FDAapproved and off-label indications. This means that more individuals are being exposed to potential adverse effects of these medications. Clinicians have frequently focused on weight gain and metabolic syndrome, tardive dyskinesia, and prolactin elevations associated with antipsychotic use. Leukopenia is a class-wide warning for all SGAs. Most clinicians associate leukopenia and neutropenia with clozapine, which requires a specific risk evaluation and mitigation strategy, but these conditions also have been observed with other antipsychotics, including risperidone, olanzapine, and quetiapine. The overriding concerns about using these medications are neutropenia and death due to infection. However, infections are common and may occur independent of neutropenia. We investigated the infection rates observed in pivotal trials of SGAs that were submitted to the FDA.","PeriodicalId":50770,"journal":{"name":"Annals of Clinical Psychiatry","volume":"33 1","pages":"53-55"},"PeriodicalIF":1.3,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25361868","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":"Panic disorder: A review of treatment options","authors":"M. Ziffra","doi":"10.12788/ACP.0014","DOIUrl":"https://doi.org/10.12788/ACP.0014","url":null,"abstract":"Background Panic disorder (PD) is a devastating illness, with numerous patients experiencing significant functional disability and many not achieving full remission with first-line pharmacologic and psychotherapeutic treatments. Methods A search of PubMed, Cochrane Library, and PsychINFO databases was used to identify publications focused on evidence-based treatment of PD. Results Selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are standard first-line pharmacologic treatments for PD. Many other antidepressants can be considered as alternatives to SSRIs, including serotonin- norepinephrine reuptake inhibitors, serotonin multimodal agents, tricyclic antidepressants, monoamine oxidase inhibitors, and mirtazapine. Certain anticonvulsants and antipsychotics may be helpful; however, the evidence base is limited. Buspirone, beta blockers, and hydroxyzine can be considered third-line agents. Currently, there is minimal data support the use of electroconvulsive therapy or repetitive transcranial magnetic stimulation (rTMS). There is very little evidence justifying the use of medical cannabis or over-the-counter supplements for PD, and these treatments have risk for adverse effects. Research strongly supports the use of cognitive-behavioral therapy (CBT) for PD. Conclusions Many options exist for the management of PD. Treatments with the strongest evidence include SSRIs, other antidepressants, and CBT. Newer interventions approved for the treatment of depression, such as serotonin multimodal agents, esketamine, and rTMS, merit further investigation for use in PD.","PeriodicalId":50770,"journal":{"name":"Annals of Clinical Psychiatry","volume":"45 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81347274","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":"Comparison of hospital course and outcome in hospital-acquired vs pre-existing delirium.","authors":"Joseph Guillory,&nbsp;Cecilia Fitz-Gerald,&nbsp;Antara Banik,&nbsp;Christopher Sterwald,&nbsp;Evelyn Ashiofu,&nbsp;Eleanore Knox,&nbsp;Mary Antoinette Muyco,&nbsp;Megan Verlage,&nbsp;Arqam Abdali,&nbsp;Patrick W O'Malley,&nbsp;Amelia Rezai,&nbsp;Paul Bush,&nbsp;E Sherwood Brown,&nbsp;Carol S North","doi":"10.12788/acp.0021","DOIUrl":"https://doi.org/10.12788/acp.0021","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a major source of morbidity in the inpatient hospital setting. This study examined differences between patients with delirium present prior to hospital admission and those with hospitalacquired delirium in several health outcomes.</p><p><strong>Methods: </strong>A total of 12,529 patients on 2 inpatient units were included in this retrospective cohort study. Outcomes were assessed using chart review. Other variables were compared across groups and included in multivariate models predicting discharge location within the hospitalacquired delirium group.</p><p><strong>Results: </strong>Of 709 patients with delirium, 83% had pre-admission prevalent and 17% had post-admission incident delirium. Compared with patients with preexisting delirium, patients with hospital-acquired delirium had greater hospital durations and mortality and were more likely to receive ICU care, more likely to receive multiple classes of medications, and less likely to be discharged home without home health services. Multivariate analysis in the hospital-acquired delirium group found that several variables independently predicted discharge location.</p><p><strong>Conclusions: </strong>Patients with hospital-acquired delirium had worse hospital outcomes and a more complicated hospital course than those with preexisting delirium. Administration of various medications, several demographic variables, and some hospital-related variables were independently associated with worse outcomes within the hospital-acquired delirium group. These results demonstrate that patients with hospitalacquired delirium are a vulnerable subgroup deserving special attention.</p>","PeriodicalId":50770,"journal":{"name":"Annals of Clinical Psychiatry","volume":"33 1","pages":"35-44"},"PeriodicalIF":1.3,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25322593","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":"Increased mortality in patients with standard EEG findings of 'diffuse slowing'.","authors":"Robert Wanzek, Nicholas Bormann, Yaseen Shabbir, Taku Saito, Thoru Yamada, Gen Shinozaki","doi":"10.12788/acp.0018","DOIUrl":"https://doi.org/10.12788/acp.0018","url":null,"abstract":"<p><strong>Background: </strong>We aimed to confirm the association between slow brain wave activity typically described as \"diffuse slowing\" on standard electroencephalogram (EEG) and patient outcomes, including mortality.</p><p><strong>Methods: </strong>This retrospective study was conducted with patient chart data from March 2015 to March 2017 at a tertiary care academic hospital in the midwestern United States. In total, 1,069 participants age ≥55 years on an inpatient floor or ICU received a standard 24-hour EEG. The primary outcome was all-cause mortality at 30, 90, 180, and 365 days. Secondary outcomes were time to discharge, and discharge to home.</p><p><strong>Results: </strong>Having diffuse slowing on standard EEG was significantly associated with 30-, 90-, 180-, and 365-day mortality compared with patients who had normal EEG findings, after controlling for age, sex, and Charlson Comorbidity Index score. When controlling for these factors, patients with diffuse slowing had a significant longer time to discharge and were significantly less likely to discharge to home. Our findings showed that a standard EEG finding of diffuse slowing for inpatients age ≥55 years is associated with poor outcomes, including greater mortality.</p><p><strong>Conclusions: </strong>This study suggested that the finding of diffuse slowing on EEG may be an important clinical marker for predicting mortality in geriatric inpatients.</p>","PeriodicalId":50770,"journal":{"name":"Annals of Clinical Psychiatry","volume":"33 1","pages":"e14-e21"},"PeriodicalIF":1.3,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934036","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":"Should we warn women against using marijuana during pregnancy?","authors":"Richard Balon","doi":"10.12788/acp.0013","DOIUrl":"https://doi.org/10.12788/acp.0013","url":null,"abstract":"Prevention and public education are the best tools for addressing the spread of many diseases and their consequences. For example, public education and other measures have led to the reduction of tobacco use and mortality rates attributable to tobacco-related cancers. It took a long time to achieve this, but as evidence of the negative effects of tobacco piled up, we acted resolutely and effectively. We now face a similar problem of epidemic proportion with the use of marijuana. Marijuana is portrayed as a mostly harmless substance compared with other drugs of abuse. We continued to hear about its possible beneficial effects for numerous conditions, yet the evidence of its benefits is frequently of low quality. Nevertheless, the drumbeat of positive press has led many states to legalize marijuana production, distribution, and use, perhaps because it brings substantial tax revenues. The marijuana industry has been skillful in marketing “medical marijuana” and in promoting its presumed benefits. This has happened despite mounting evidence of the negative consequences of marijuana use, which are not “just” psychiatric. The latest warning has come from a Scientific Statement from the American Heart Association: “Patients with underlying ischemic disease could see an increase in angina, particularly when cannabis is smoked.” Some evidence suggests that cannabis use may be a trigger for acute myocardial infarction and may be linked to a “higher risk of cerebrovascular accident and heart failure.” Reports of the negative consequences of and warnings about marijuana use have focused on those who make a personal choice to use the substance. But what about those who are exposed to marijuana unwillingly, namely children who are exposed to it at home by relatives and others who are users, or fetuses exposed to marijuana prenatally? We do not know much about the consequences of second-hand exposure to marijuana. However, the negative consequences of prenatal marijuana exposure are becoming evident. Several studies have reported evidence for negative consequences such as fetal growth reduction, or the development of delinquent behavior at age 14 years. One scientific review reported on the alterations of endocannabinoid neurotransmission at critical developmental ages (based on rodent studies). Another review reported that marijuana use during pregnancy and lactation Richard Balon, MD Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology Wayne State University Detroit, Michigan, USA","PeriodicalId":50770,"journal":{"name":"Annals of Clinical Psychiatry","volume":"33 1","pages":"1-2"},"PeriodicalIF":1.3,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25322591","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":"Doll therapy in dementia: Facts and controversies.","authors":"Kala Chinnaswamy,&nbsp;Dominic M DeMarco,&nbsp;George T Grossberg","doi":"10.12788/acp.0010","DOIUrl":"https://doi.org/10.12788/acp.0010","url":null,"abstract":"<p><strong>Background: </strong>The management of major neurocognitive disorder (MNCD), formerly known as dementia, is of increasing concern as the elderly population continues to grow. Doll therapy (DT) is a controversial method observed in clinical practice that has both promising benefits and potential ethical concerns. To date, little research has been done on this therapy.</p><p><strong>Methods: </strong>A PubMed search was performed using the keywords \"dementia,\" \"elderly,\" \"dolls,\" \"doll therapy,\" and \"Alzheimer's disease.\" A list of pertinent articles was assembled, with irrelevant articles excluded. References from these articles were also reviewed and additional articles were included in the final list.</p><p><strong>Results: </strong>Research on the utility of DT for patients with MNCD is limited. Current literature suggests that DT may be beneficial in decreasing the use of pharmacologic interventions and alleviating symptoms such as agitation and anxiety. However, most studies consisted of small, unrepresentative sample populations.</p><p><strong>Conclusions: </strong>Preliminary studies favor DT as an effective management strategy for behavioral symptoms of MNCD. However, the few existing randomized controlled trials are limited in size and demographics. Further research involving larger, more diverse study samples with more male patients is needed. Additionally, the exact parameters to guide this therapy have not been established and require investigative study.</p>","PeriodicalId":50770,"journal":{"name":"Annals of Clinical Psychiatry","volume":"33 1","pages":"58-66"},"PeriodicalIF":1.3,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38546658","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":"White matter pathology in patients with borderline personality disorder: A review of controlled DTI studies.","authors":"Raza Sagarwala,&nbsp;Henry A Nasrallah","doi":"10.12788/acp.0001","DOIUrl":"https://doi.org/10.12788/acp.0001","url":null,"abstract":"<p><strong>Background: </strong>Neuroimaging, especially diffusion tensor imaging (DTI), has emerged as a helpful tool in assessing and characterizing white matter (WM) integrity. The resultant early treatment from early diagnosis is crucial because treatment is often more efficacious. Borderline personality disorder (BPD) is a challenging disorder to diagnose and treat, and has been reported to have various neurobiologic abnormalities. We conducted a search of the literature to review WM pathology findings in BPD.</p><p><strong>Methods: </strong>A search was conducted to identify systematic reviews and meta-analyses published from January 2000 to September 2019 that assessed WM integrity in BPD.</p><p><strong>Results: </strong>Four studies were included. One study demonstrated no difference in WM between BPD and healthy controls. Another study found decreased fractional anisotropy (FA) within the corpus callosum (CC) and orbitofrontal regions. A subsequent randomized controlled trial reported a decrease in FA within the fornix, CC, and right superior/anterior corona radiata with associated increase in radial diffusivity in the left anterior thalamic radiation. The fourth study found a decrease in the axial diffusivity within the cingulum, inferior longitudinal fasciculus, and inferior frontoccipital fasciculus.</p><p><strong>Conclusions: </strong>Our review concludes that BPD is associated with measurable WM pathology. Methods such as DTI might emerge as useful tools in the management of BPD. More controlled studies are needed to validate our conclusions.</p>","PeriodicalId":50770,"journal":{"name":"Annals of Clinical Psychiatry","volume":"32 4","pages":"281-286"},"PeriodicalIF":1.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38546654","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":"Acutely ill psychiatric inpatients and antimicrobial exposure.","authors":"Kaitlin P Kehoe,&nbsp;Brian J Miller","doi":"10.12788/acp.0002","DOIUrl":"https://doi.org/10.12788/acp.0002","url":null,"abstract":"<p><strong>Background: </strong>Patients with schizophrenia, bipolar disorder, and major depressive disorder (MDD) have increased infections. We explored the association between recent antimicrobial exposure and acute psychiatric illness.</p><p><strong>Methods: </strong>We performed a retrospective chart review of 267 acutely ill patients age 18 to 65. There were 92 patients with schizophrenia, 42 with bipolar disorder, 61 with MDD, and 72 with alcohol use disorders (hospitalized controls). Recent antimicrobial exposure was defined as occurring within 3 days of psychiatric hospitalization.</p><p><strong>Results: </strong>The prevalence of recent antimicrobial exposure was significantly increased in acutely ill patients with schizophrenia (16%), bipolar disorder (21%), and MDD (18%) compared with patients who had alcohol use disorders (4%, P ≤ .01 for each). After controlling for potential confounders, participants with schizophrenia or mood disorders were 5 to 7 times more likely to have recent antimicrobial exposure than participants with alcohol use disorders (schizophrenia: odds ratio [OR] = 4.5, 95% confidence interval [CI] 1.0-21.0, P = .053; bipolar disorder: OR = 6.9, 95% CI 1.3-35.7, P = .022; MDD: OR = 5.7, 95% CI 1.2-28.3, P = .032). Among participants with mood disorders, the association was stronger for participants with depression and affective psychosis compared with participants with alcohol use disorders.</p><p><strong>Conclusions: </strong>We found an increased prevalence of recent antimicrobial exposure in acutely ill patients with schizophrenia and mood disorders. The findings provide additional evidence that infections are relevant to acute psychiatric illness.</p>","PeriodicalId":50770,"journal":{"name":"Annals of Clinical Psychiatry","volume":"32 4","pages":"229-238"},"PeriodicalIF":1.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38642732","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":"Kratom: A growing substance of abuse in the United States.","authors":"Daniel Stephen Demick,&nbsp;Taelor T Lee,&nbsp;Audrey T Summers,&nbsp;Rif S El-Mallakh","doi":"10.12788/acp.0012","DOIUrl":"https://doi.org/10.12788/acp.0012","url":null,"abstract":"<p><strong>Background: </strong>Use of kratom is increasing in the United States due to its perceived safety as a botanical product. This review provides salient information about kratom for the practicing clinician.</p><p><strong>Methods: </strong>We conducted a literature search of MedLine, UpToDate, and Google using the terms \"kratom\" and \"Mitragyna speciosa\" for articles published within the last 10 years.</p><p><strong>Results: </strong>We reviewed > 500 articles. Kratom is derived from the Mitragyna speciosa plant of Southeast Asia. It has grown in popularity within the United States due to its dual effects of acting as a stimulant at low doses and acting as an opioid-like substance at higher dosages. The 2 major active ingredients in kratom, mitragynine and 7-OH mitragynine, act as partial agonists at the mu-opioid receptor. While adverse consequences are normally mild, there are several potentially serious adverse effects, including respiratory depression, especially with chronic, high-dose usage. Furthermore, in case reports, concomitant use of kratom with other substances has been linked to seizures. Unfortunately, an increasing number of deaths have been linked to kratom usage. Six states have made it illegal to possess or sell kratom.</p><p><strong>Conclusions: </strong>Kratom is an emerging drug of abuse in the United States. Its use is increasing in individuals who may seek to experience an opioidlike \"high\" as well as to help reduce withdrawal effects from other opioids.</p>","PeriodicalId":50770,"journal":{"name":"Annals of Clinical Psychiatry","volume":"32 4","pages":"275-280"},"PeriodicalIF":1.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38210278","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 precipitous decline of academic medicine in the United States.","authors":"Richard Balon,&nbsp;Mary K Morreale","doi":"10.12788/acp.0006","DOIUrl":"https://doi.org/10.12788/acp.0006","url":null,"abstract":"The recent coronavirus pandemic has made us more aware of the gradual decline of academic medicine. Although much has been written about the systemic problems in medicine and academia (mostly in the context of burnout and well-being), the problems in academic medicine extend well beyond these concerns. Structural problems in academic medicine exist within all parts of its tripartite mission: education, clinical care, and research. With clinical care, there are tedious requirements for documentation in difficult-to-navigate electronic medical record systems, demands on productivity in the form of ever-increasing allocated Relative Value Units (RVUs), and senseless demands from managed-care organizations. All of these clinical demands reduce the time for teaching, which, ironically, university deans expect us instructors to increase. Similarly, education has been increasingly regulated by what has been referred to as the “medical-education industrial complex.” Regulatory agencies have introduced changes with possibly negative consequences and no evident benefit. The promise that the new accreditation system would make residency training programs easier to manage has not materialized and, actually, the opposite appears true. In addition, unfunded mandates of questionable value have been introduced, such as the Clinical Skills Verification examination. Academic research—at least in psychiatry—has been experiencing an “intellectual crisis,” leading to the conclusion that “evidence-based medicine does not appear to provide an adequate scientific background for challenges of clinical practice in psychiatry and needs to be integrated with clinical judgment.” Some argue that the scope of evidence-based medicine is limited and should be combined with practice-based evidence in making clinical decisions. And despite the glow that research funding brings to investigators and administrators, the sad fact is that, for the institution, research is a money loser. The pandemic has lifted the veil on even more serious threats to academic medicine. In a recent article, Johns Hopkins University Professor Richard Balon, MD Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology Wayne State University Detroit, Michigan, USA","PeriodicalId":50770,"journal":{"name":"Annals of Clinical Psychiatry","volume":"32 4","pages":"225-227"},"PeriodicalIF":1.3,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38642731","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}