Journal of the Academy of Consultation-Liaison Psychiatry最新文献

{"title":"A Case Series of 11 Patients With Subacute Serotonin Syndrome","authors":"John Patrick B. Janowski M.D. ,&nbsp;Laura Suarez M.D.,&nbsp;Nicholas D. Allen M.D.,&nbsp;Shirlene M. Sampson M.D., M.S","doi":"10.1016/j.jaclp.2023.10.004","DOIUrl":"10.1016/j.jaclp.2023.10.004","url":null,"abstract":"<div><h3>Background</h3><p>Serotonin syndrome is an acute, life-threatening illness characterized by mental status changes, neuromuscular symptoms, and autonomic instability. Some patients taking serotonergic antidepressants have been noted to have unexplained mental status changes and/or neuromuscular changes without autonomic instability raising the possibility of a more chronic or attenuated form of serotonin syndrome.</p></div><div><h3>Objective</h3><p>Assessment of antidepressant blood levels to support the diagnosis of a subacute serotonin syndrome.</p></div><div><h3>Methods</h3><p>At a tertiary psychiatric outpatient clinic, patients with unexplained mental status and/or neuromuscular changes without autonomic instability had antidepressant blood levels assessed.</p></div><div><h3>Results</h3><p>Eleven patients were identified with signs and symptoms partially consistent with serotonin syndrome. Nine patients had cognitive changes, while four patients had motor changes, and three patients had psychosis. All patients had elevated blood levels of a single serotonergic antidepressant. Limited follow-up suggests that symptoms improve with reduction of antidepressant medication.</p></div><div><h3>Conclusions</h3><p>These cases suggest that a more chronic, attenuated form of serotonin syndrome exists. Diagnostic criteria are proposed for a distinct clinical entity: subacute serotonin syndrome (SSS). Further research is required to validate these criteria. Clinicians should consider drawing antidepressant levels for patients with symptoms and signs suggestive of SSS—especially those at increased vulnerability for excessive serotonergic agonism. Given the high prevalence of antidepressant medication use, the awareness of SSS could lead to improved patient outcomes and public health.</p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667296023001349/pdfft?md5=54242c2935de0586a69821d23a764c7e&pid=1-s2.0-S2667296023001349-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dyspnea and Dyspnea-Associated Anxiety in the ICU Patient Population: A Narrative Review for CL Psychiatrists","authors":"Yelizaveta Sher M.D. ,&nbsp;Nikita Desai M.D. ,&nbsp;Jon Sole M.D. ,&nbsp;Melissa Patricia D'souza M.D.","doi":"10.1016/j.jaclp.2023.11.001","DOIUrl":"10.1016/j.jaclp.2023.11.001","url":null,"abstract":"<div><h3>Background</h3><p>Consultation-liaison psychiatrists frequently address dyspnea in intensive care unit (ICU) patients. Dyspnea is common in this patient population, but is frequently misunderstood and underappreciated in noncommunicative ICU patients.</p></div><div><h3>Objective</h3><p>This paper provides an updated review on dyspnea specifically in the ICU population, including its pathophysiology and management, pharmacological and nonpharmacological, aimed at consultation-liaison psychiatrists consulting in ICU.</p></div><div><h3>Methods</h3><p>A literature review was conducted with PubMed, querying published articles for topics associated with dyspnea and dyspnea-associated anxiety in ICU patient populations. When literature in ICU populations was limited, information was deduced from dyspnea and anxiety management from non-ICU populations. Articles discussing the definition of dyspnea, mechanistic pathways, screening tools, and pharmacologic and nonpharmacologic management were included.</p></div><div><h3>Results</h3><p>A reference guide was created to help consultation-liaison psychiatrists and intensivists in the screening and treatment of dyspnea and dyspnea-associated anxiety in critically ill patients.</p></div><div><h3>Conclusions</h3><p>Dyspnea is frequently associated with anxiety, prolonged days on mechanical ventilation, and worse quality of life after discharge. It can also increase the risk of posttraumatic stress disorder post-ICU discharge. However, it is not routinely screened for, identified, or addressed in the ICU. This manuscript provides an updated review on dyspnea and dyspnea-associated anxietyin the ICU population, including its pathophysiology and management, and offers a useful reference for consultation-liaison psychiatrists to provide treatment recommendations.</p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667296023001441/pdfft?md5=a3b07ce1f88f548af832d2bef9f53353&pid=1-s2.0-S2667296023001441-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compassion in Consultation-Liaison Psychiatry and Call for Advocacy for Patients with Severe Mental Illness","authors":"Hochang Benjamin Lee M.D.","doi":"10.1016/j.jaclp.2024.01.002","DOIUrl":"10.1016/j.jaclp.2024.01.002","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667296024000028/pdfft?md5=e722aa00cebe201742aa04bb5d3c117f&pid=1-s2.0-S2667296024000028-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Cholinergic Rebound After Abrupt Withdrawal of Clozapine: A Case Report and Systematic Literature Review","authors":"Lucy Bickerton M.D. ,&nbsp;Jisha Lovin Kuriakose M.D.","doi":"10.1016/j.jaclp.2023.10.001","DOIUrl":"10.1016/j.jaclp.2023.10.001","url":null,"abstract":"<div><h3>Background</h3><p>Cholinergic discontinuation symptoms, also known as “cholinergic rebound,” from abrupt clozapine discontinuation are characterized by a range of somatic and psychiatric symptoms.</p></div><div><h3>Objective</h3><p>The objective of this study was to describe the clinical features and management options for clozapine withdrawal–associated cholinergic rebound syndrome (henceforth referred to as CWCRS) and present an illustrative case report.</p></div><div><h3>Methods</h3><p>Based on a literature search of the databases PubMed, OVID Medline, and Embase as well as reviewing reference lists of relevant past reviews, we carried out a systematic review of case reports on the management of CWCRS from 1946 to 2023.</p></div><div><h3>Results</h3><p>We identified 10 previously published articles on the clinical management of CWCRS, with a total of 18 patients (6 female, 12 male) with an average age of 43 years (standard deviation 14). Half of the patients had a history of tardive dyskinesia. The mean dose of clozapine before discontinuation was 351 mg/day, with duration of clozapine treatment ranging from 3 weeks to 9 years. Clozapine was the most effective treatment, followed by benztropine.</p></div><div><h3>Conclusions</h3><p>Given the small number of cases and the nonexperimental nature of the available studies, this review could not provide reliable data to guide management of CWCRS. The findings, however, suggest that clozapine may be more effective than other commonly used treatment options. With the high rates of discontinuation among patients on clozapine, there is a pressing need for further research into the epidemiology, natural history, and management of clozapine withdrawal syndromes.</p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667296023001313/pdfft?md5=1237bee0927002931d32f7012d8b9297&pid=1-s2.0-S2667296023001313-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41219915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma Spectrum Disorder Symptoms Presenting as Psychosis Following Emergent Hysterectomy With Fetal Demise: Differential Diagnostic Considerations","authors":"Samuel P. Greenstein M.D.,&nbsp;Xavier Jimenez M.D.","doi":"10.1016/j.jaclp.2023.07.003","DOIUrl":"10.1016/j.jaclp.2023.07.003","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10008645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Impact of ECHO Ontario Integrated Mental and Physical Health on Participants' Approach and Attitude Toward the Care of Patients With Complex Needs","authors":"Kathleen A. Sheehan MD, DPhil ,&nbsp;Jake Chaput BSc ,&nbsp;Victoria Bond MSc ,&nbsp;Javed Alloo MD ,&nbsp;Mark Bonta MD ,&nbsp;Sophie Soklaridis PhD ,&nbsp;Maria Zhang BScPhm, PharmD ,&nbsp;Sanjeev Sockalingam MD, MHPE","doi":"10.1016/j.jaclp.2023.07.004","DOIUrl":"10.1016/j.jaclp.2023.07.004","url":null,"abstract":"<div><h3>Objective</h3><p>To examine how project Extension for Community Healthcare Outcomes–Integrated Mental and Physical Health (ECHO-IMPH) influences the attitudes and approaches of primary care providers and other participants towards patients.</p></div><div><h3>Methods</h3><p>An exploratory qualitative approach was undertaken using semistructured interviews conducted between August 2020 and March 2021. One hundred and sixty-four individuals from two cycles of ECHO-IMPH were invited to participate, and 22 (n = 22) agreed to participate. Data were analyzed using the Braun and Clarke method for thematic analysis.</p></div><div><h3>Results</h3><p>Three major themes were identified: 1) enhanced knowledge and skills; 2) changes in attitude and approach; 3) space for reflection and exploration. When participants were asked about areas for improvement, suggestions were focused on the structure of the sessions. Participants identified that ECHO-IMPH helped them to view patients more holistically, which led to greater patient-centered care in their practice. Additionally, skills gained in ECHO-IMPH gave participants the concrete tools needed to have more empathetic interactions with patients with complex needs.</p></div><div><h3>Conclusions</h3><p>ECHO-IMPH created a safe space for participants to reflect on their practice with patients with complex needs. Participants applied newly acquired knowledge and skills to provide more empathetic and patient-centered care for patients with complex needs. Based on the shift in perspectives described by participants, transformative learning theory was proposed as a model for how ECHO-IMPH created change in participants' practice.</p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10130280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"(206) Impacts on Women's Mental Health Following COVID-19 Infection During Delivery: A Qualitative Study","authors":"Ashley Cantu-Weinstein, Katherine E. Taljan, Kelly Bowen, Audrey DeLong, O. Goje","doi":"10.1016/j.jaclp.2023.11.674","DOIUrl":"https://doi.org/10.1016/j.jaclp.2023.11.674","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139291668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"(158) Comparison of Suicide Risk Identification in Adult Healthcare Encounters With and Without Universal Screening: Analysis of Age Group and Reason for Encounter","authors":"Julia Livingstone, Olivia Hudgens, Beth A. Childs, Alex Treacher, Jacqueline Naeem, Sandra Chrzaszcz, Arun Nethi, Ashley Steele, Kimberly Roaten","doi":"10.1016/j.jaclp.2023.11.628","DOIUrl":"https://doi.org/10.1016/j.jaclp.2023.11.628","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139292993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"(110) Management of Intractable Psychosis in a Patient with Hereditary Aceruloplasminemia-associated Neurodegeneration: The Role of Electroconvulsive Therapy","authors":"Timothy Adegoke, Vicky Wang, Kathy Niu, Jonathan Smith","doi":"10.1016/j.jaclp.2023.11.583","DOIUrl":"https://doi.org/10.1016/j.jaclp.2023.11.583","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139293121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"(118) Psychiatric Manifestations of Micronutrient Deficiency in a Post-Operative Bariatric Surgery Patient on Semaglutide","authors":"Zehra Aftab, Emilie Sohl, Zachary Bean","doi":"10.1016/j.jaclp.2023.11.591","DOIUrl":"https://doi.org/10.1016/j.jaclp.2023.11.591","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139293308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}