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

{"title":"CL Case Conference: Managing Substance Use and Agitation in Pregnancy.","authors":"J Reid Black, Elizabeth Hovis, Meredith L Spada, Li Li","doi":"10.1016/j.jaclp.2025.02.002","DOIUrl":"10.1016/j.jaclp.2025.02.002","url":null,"abstract":"<p><p>We present the case of a 29-year-old G1P0 female at 21 weeks of gestational age with stimulant use disorder, substance-induced psychosis, and agitation who is admitted to obstetrics and gynecology. During her hospitalization, consultation-liaison psychiatry plays an important role in managing her psychotropic regimen and determining appropriate safety precautions. Subject matter experts examine critical aspects of psychiatric care in pregnancy and liaising with obstetric services, including protocols for unit placement, suicide risk assessment, and medicolegal considerations such as involuntary commitment, medical decision-making capacity, and mandated reporting. Special attention is given to the management of agitation as an obstetric emergency, with detailed guidance on both nonpharmacologic and pharmacologic treatment strategies. We also discuss stimulant use disorder in pregnancy, including epidemiology, risk factors, potential treatment options, and barriers to receiving care.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469886","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":"Developing a Clinical Workflow for Early Recognition and Diagnosis of Autoimmune Encephalitis in Patients Presenting With Atypical Psychosis.","authors":"Grace Russo, Lucy Jia, Carla Y Kim, Konstantin Stojanovic, Sarah F Wesley, George H Denfield, Paula Askalsky, Gad Noy, Kiran T Thakur","doi":"10.1016/j.jaclp.2025.02.001","DOIUrl":"10.1016/j.jaclp.2025.02.001","url":null,"abstract":"<p><strong>Background and objective: </strong>Atypical psychosis is often difficult to diagnose and treat, and delays in identifying the underlying etiology can worsen patient outcomes. We present a novel clinical workflow for patients presenting to the emergency department with features of atypical psychosis to standardize the diagnostic process with the goal of earlier recognition and diagnosis of autoimmune encephalitis.</p><p><strong>Methods: </strong>Through literature review and multidisciplinary discussions, we developed a clinical workflow to direct patient management and diagnostic testing using the following identified \"red\" and \"yellow\" flags of atypical psychosis: unexplained seizures, focal neurologic deficits, autonomic instability, movement disorder in the absence of antipsychotics, hyponatremia, age greater than 40 years, psychosis refractory to 2 appropriate treatment trials, infectious or systemic prodrome, and history of malignancy. We then reviewed electronic medical records to assess the disposition and outcomes of patients who underwent the workflow.</p><p><strong>Results: </strong>From January 2022 to September 2023, 38 patients presenting with atypical psychosis were assessed using our new workflow in the Comprehensive Psychiatric Emergency Program. Most patients (23/38) entered the workflow due to one yellow flag, and age greater than 40 years was the most frequent flag feature (31/38). Ultimately, 57.9% (22/38) were diagnosed with primary psychiatric disorders, while 15.8% (6/38) had primary neurological diagnoses, including 3 immune-mediated cases. A survey of neurology and psychiatry team members showed the workflow was generally viewed as straightforward and effective.</p><p><strong>Conclusions: </strong>Our novel clinical workflow facilitated early neurologic consultation and management of patients presenting with atypical psychosis, identifying both immune-mediated and nonimmune-mediated neurologic disorders.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460529","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":"Variation in Structural Characteristics Among 20 Medical Psychiatry Units in the United States: A Survey-Based Study.","authors":"Petra J Caarls, Luc A W Jansen, Jan J van Busschbach, Roger G Kathol, Maarten A van Schijndel","doi":"10.1016/j.jaclp.2025.01.006","DOIUrl":"10.1016/j.jaclp.2025.01.006","url":null,"abstract":"<p><strong>Background: </strong>Medical psychiatric units (MPUs) are specialized hospital units providing integrated care for patients with co-occurring medical and psychiatric illnesses. Despite their growing relevance, data on their structural characteristics in the United States remain sparse. This study aims to inventory and analyze the structural characteristics of 20 US MPUs, categorizing them using Kathol's and Van Schijndel's frameworks, and identifying shared components to inform future MPU design and quality standards.</p><p><strong>Methods: </strong>A structured telephone survey was conducted with 20 MPUs from 15 states. Units were categorized as medical attending MPUs, psychiatric attending MPUs, or co-attending MPUs, based on physician involvement. Characteristics assessed included medical and psychiatric acuity capabilities, staffing, physical design, and diagnostic services. Data were analyzed for shared and variable characteristics, and findings were compared with prior studies.</p><p><strong>Results: </strong>Most MPUs aligned with Kathol's Type III, characterized by medium to high medical and psychiatric acuity capabilities. Shared characteristics included integrated nursing practices, 24/7 diagnostic availability, and access to intensive care unit-level care. However, significant variation existed in location, staffing, and technical capabilities. Most units were psychiatry attending or co-attending MPUs.</p><p><strong>Conclusions: </strong>The US MPUs included primarily serve patients with medium to severe medical and psychiatric illnesses. Our findings highlight shared and variable features across MPUs, emphasizing the role of contextual needs and financial incentives in shaping their design. This study provides the most comprehensive inventory of US MPUs to date and proposes features to guide future MPU development and standardization.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081985","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":"Hartnup Disease-Associated Psychosis: A Dwindling Phenomenon or Just Underreported?","authors":"Mark Ainsley Colijn","doi":"10.1016/j.jaclp.2025.01.004","DOIUrl":"10.1016/j.jaclp.2025.01.004","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076557","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":"A Case of Avoidant/Restrictive Food Intake Disorder in an Adult With Schizophrenia and Obsessive-Compulsive Disorder.","authors":"Raissa Li, Varsha Radhakrishnan","doi":"10.1016/j.jaclp.2025.01.005","DOIUrl":"10.1016/j.jaclp.2025.01.005","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076556","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":"Treating to Capacity: A Case of Mesenteric Ischemia Complicated by Psychotic Depression.","authors":"Arjun Mann, Flannery Merideth","doi":"10.1016/j.jaclp.2025.01.003","DOIUrl":"10.1016/j.jaclp.2025.01.003","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043333","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":"Recognizing Withdrawal From Psychoactive Substances Purchased Online.","authors":"Cecilia N Hollenhorst, Brent Schnipke","doi":"10.1016/j.jaclp.2025.01.002","DOIUrl":"10.1016/j.jaclp.2025.01.002","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967153","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":"Successful Use of the Cultural Formulation Interview for Assessment and Management of a Migrant Patient With Anorexia Nervosa.","authors":"Christine Huynh, Nana Park, Nia Harris, Diana Punko","doi":"10.1016/j.jaclp.2025.01.001","DOIUrl":"10.1016/j.jaclp.2025.01.001","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967171","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":"Clinical Utility and Performance of the Traditional Chinese Version of the 4-As Test for Delirium due to Traumatic Brain Injury.","authors":"Yun-Hsuan Lai, Chia-Jou Lin, I-Chang Su, Sheng-Wen Huang, Chia-Chi Hsiao, Ying-Ling Jao, Pin-Yuan Chen, Victoria Traynor, Chuan-Ya Lee, Ting-Jhen Chen, Mu-Hsing Ho, Hsiao-Yean Chiu","doi":"10.1016/j.jaclp.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.jaclp.2024.12.005","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a common symptom following a traumatic brain injury that is often overlooked by healthcare professionals. Early detection of posttraumatic delirium is crucial to improving patient outcomes and quality of life. The 4 As Test (4AT: alertness, attention, abbreviated mental test-4, and acute mental changes) is a brief and rapid tool for delirium assessment with acceptable reliability and validity. However, the 4AT has not yet been translated for use in the Taiwanese population.</p><p><strong>Objective: </strong>To translate the 4AT into Traditional Chinese (TC-4AT), assess its reliability and validity, and explore the clinical effects of delirium in patients with a traumatic brain injury.</p><p><strong>Methods: </strong>This prospective observational study was conducted at the neurosurgery wards of 2 Taiwanese hospitals. Patients who were aged 20 years or older, were diagnosed with a traumatic brain injury, and had a Glasgow Coma Scale score between 13 and 15 were included. Interrater reliability was assessed, and validity was verified using criterion-related comparisons with the Short Confusion Assessment Method. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were employed to assess the sensitivity and specificity of the TC-4AT for screening posttraumatic brain injury delirium.</p><p><strong>Results: </strong>A total of 100 patients with an average age of 67 years were enrolled, of whom 10% were diagnosed with delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The interrater reliability of the TC-4AT was 1.00. Patients with delirium tended to have a longer hospital stay than those without delirium (13 days vs. 7 days) although the difference was nonsignificant (P = 0.28). In terms of criterion validity, patients diagnosed with delirium using the Short Confusion Assessment Method had a significantly higher score on the TC-4AT than those not diagnosed with delirium (P < 0.001). The receiver operating characteristic curve indicated that the optimal cutoff point was 4, with sensitivity, specificity, and area under the characteristic curve of 0.90, 0.94, and 0.96, respectively.</p><p><strong>Conclusion: </strong>The TC-4AT is an accurate tool for delirium assessment that aids early detection and in informed decision-making in preventive care.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069626","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":"Bromocriptine for Residual Catatonia Following Neuroleptic Malignant Syndrome: Illustrative Case Report and Systematic Review.","authors":"Bernard Sarmiento, Matthew Gunther, Alexis Cohen-Oram, Shixie Jiang","doi":"10.1016/j.jaclp.2024.12.003","DOIUrl":"10.1016/j.jaclp.2024.12.003","url":null,"abstract":"<p><strong>Background: </strong>Neuroleptic malignant syndrome (NMS) is a rare yet potentially fatal iatrogenic syndrome that can manifest with life-threatening symptoms. Theorized to be caused by the dopamine-blocking effects of certain medications, such as antipsychotics, or the withdrawal of dopaminergic agents, NMS is characterized by hyperthermia, autonomic instability, altered mental status, and muscular rigidity. Most treated cases resolve within weeks; however, in some cases, residual catatonic symptoms can persist for months after the resolution of acute hyperthermic and hypermetabolic symptoms. The utilization of dopaminergic agents, such as bromocriptine, to alleviate the catatonic symptoms of NMS has been described in the literature but has not been explored systematically.</p><p><strong>Objective: </strong>The objective of this study is to present a case where high-dose bromocriptine was used to successfully treat significant, residual catatonia following NMS and to further delineate the role of bromocriptine in the management of residual catatonia secondary to NMS through a systematic review.</p><p><strong>Methods and results: </strong>This study presents an illustrative case report and a systematic review of bromocriptine use in managing residual NMS catatonia. The databases of PubMed, Cochrane, PsycINFO, EBSCO, and OVID Medline were queried, identifying 338 studies. Utilizing COVIDENCE, 137 duplicate articles and 76 irrelevant studies were excluded. Ultimately, 125 studies were assessed for eligibility, yielding 7 manuscripts and 9 total cases of bromocriptine use in residual NMS catatonia. Including our case, bromocriptine use led to an improvement in catatonic symptoms in 80.0% of patients (8 out of 10) and resolved catatonic symptoms in 50.0% of patients (5 out of 10).</p><p><strong>Conclusions: </strong>Based on this case and the accompanying systematic review, bromocriptine may serve as an effective treatment for residual catatonia following NMS, particularly when first-line strategies such as benzodiazepine and/or electroconvulsive therapy treatment have failed or are infeasible. This highlighted efficacy of bromocriptine may be attributed to relieving persistent dopaminergic blockade in susceptible patients, necessitating further research into the etiological heterogeneity of catatonia.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932528","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}