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Journal of Psychiatric Practice

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https://www.readbyqxmd.com/read/28492463/impact-of-an-alcohol-withdrawal-treatment-pathway-on-hospital-length-of-stay-a-retrospective-observational-study-comparing-pre-and-post-pathway-implementation
#1
Andrew J Muzyk, Rachel E Rogers, Gary Dighe, Jessica Hartung, Robert C Musser, Mary J Stillwagon, Sarah Rivelli
OBJECTIVE: To determine if the implementation of a hospital-specific alcohol withdrawal treatment pathway used in a medical-surgical patient population decreased hospital length of stay (LOS) compared with the standard of care. METHODS: This retrospective observational study, conducted in a large academic tertiary care hospital, involved 582 subjects who met criteria for study inclusion, with 275 subjects in the 2010 cohort and 307 in the 2012 cohort. The Alcohol Withdrawal Project Team was formed with the goal of creating a standardized approach to the recognition and treatment of alcohol withdrawal at Duke University Hospital...
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28492462/synthetic-cannabinoids-use-in-elderly-patients
#2
Nahla Mahgoub, Robert C Young
Synthetic cannabinoids are becoming a public health concern. No data are apparently available concerning use of synthetic cannabinoids in the elderly. We report two cases of elderly individuals who used synthetic cannabinoids and were admitted to a psychiatric hospital.
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28492461/overcoming-barriers-to-initiating-medication-assisted-treatment-for-heroin-use-disorder-in-a-general-medical-hospital-a-case-report-and-narrative-literature-review
#3
Sameer Hassamal, Matthew Goldenberg, Waguih Ishak, Margaret Haglund, Karen Miotto, Itai Danovitch
Deaths due to heroin overdoses are increasing and are the leading cause of death among intravenous heroin users. Although medication-assisted treatment (MAT) improves morbidity and mortality in patients with opioid use disorders, it is underutilized. Most efforts to expand access to MAT have focused on outpatient settings. Although the inpatient medical setting presents a critical opportunity to initiate treatment, general hospitals are often unfamiliar with MAT, creating a number of barriers to its use. In this report, we describe the case of a woman with heroin use disorder who was initiated on buprenorphine maintenance treatment while hospitalized for cardiac disease related to her intravenous heroin use...
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28492460/performance-validity-testing-in-neuropsychology-methods-for-measurement-development-and-maximizing-diagnostic-accuracy
#4
Thomas R Wodushek, Michael R Greher
In the first column in this 2-part series, Performance Validity Testing in Neuropsychology: Scientific Basis and Clinical Application-A Brief Review, the authors introduced performance validity tests (PVTs) and their function, provided a justification for why they are necessary, traced their ongoing endorsement by neuropsychological organizations, and described how they are used and interpreted by ever increasing numbers of clinical neuropsychologists. To enhance readers' understanding of these measures, this second column briefly describes common detection strategies used in PVTs as well as the typical methods used to validate new PVTs and determine cut scores for valid/invalid determinations...
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28492459/making-psychotherapy-great-again
#5
Eric M Plakun
Psychotherapy never stopped being as "great" as other treatments. This column explores the evidence base for both psychotherapy and medications, using depression as a specific example. The limitations are comparable for psychotherapy and medication, with much of the evidence based on small degrees of "statistically significant" rather than "clinically meaningful" change. Our field's biomedical emphasis leads to a false assumption that most patients present with single disorders, when comorbidity is the rule rather than the exception...
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28492458/switching-from-the-oral-to-the-depot-formulation-of-a-medication-clinically-relevant-pharmacokinetic-concepts-and-considerations
#6
Sheldon H Preskorn
This column presents principles that will aid the prescriber in transitioning patients from an oral to a depot antipsychotic medication. The column covers the differences in the pharmacokinetics of oral versus depot formulations that are critical in making a smooth transition. Also discussed are some of the reasons to use these medications, which, in the author's opinion, are currently underutilized. This column focuses on the big picture and the fundamentals of oral versus depot formulations rather than comparing the relative merits or potential advantages of the various marketed depot formulations...
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28492457/the-role-of-amantadine-withdrawal-in-3-cases-of-treatment-refractory-altered-mental-status
#7
Leah D Fryml, Kristen R Williams, Christopher G Pelic, James Fox, Gregory Sahlem, Sophie Robert, Gonzalo J Revuelta, Edward Baron Short
Amantadine, which was originally developed as an antiviral medication, functions as a dopamine agonist in the central nervous system and consequently is utilized in the treatment of Parkinson disease, drug-induced extrapyramidal reactions, and neuroleptic malignant syndrome. For reasons that are not entirely understood, abrupt changes in amantadine dosage can produce a severe withdrawal syndrome. Existing medical literature describes case reports of amantadine withdrawal leading to delirium, which at times has progressed to neuroleptic malignant syndrome...
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28492456/calmer-life-a-hybrid-effectiveness-implementation-trial-for-late-life-anxiety-conducted-in-low-income-mental-health-underserved-communities
#8
Srijana Shrestha, Nancy Wilson, Mark E Kunik, Paula Wagener, Amber B Amspoker, Terri Barrera, Jessica Freshour, Cynthia Kraus-Schuman, Jane Bavineau, Maria Turner, Melinda A Stanley
OBJECTIVE: Anxiety is common among older adults and is associated with multiple negative outcomes. Late-life anxiety is usually unrecognized by providers and undertreated, although evidence supports the effectiveness of psychosocial treatment. Access to mental health care is especially poor among African American seniors. New treatment models are needed to expand the reach of mental health care to minority elders. METHODS: Our article outlines a study designed to test the effectiveness and implementation potential of Calmer Life (CL), a community-based, person-centered, flexible and culturally tailored intervention for late-life anxiety and worry, offered in low-income, mental health-underserved and predominantly African American communities...
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28492455/reevaluating-antidepressant-selection-in-patients-with-bruxism-and-temporomandibular-joint-disorder
#9
Royce Rajan, Ye-Ming Sun
Temporomandibular joint disorder (TMD) is a broad pain disorder that refers to several conditions affecting the temporomandibular joint of the jaw and the muscles of mastication. As with most pain disorders, a high prevalence of depression and anxiety is associated with TMD. Research has shown that selective serotonin reuptake inhibitors (SSRIs), the first-line drug therapy for major depressive disorder, may not be suitable for TMD patients because SSRIs can induce teeth-grinding, otherwise known as bruxism...
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28492454/use-of-lithium-in-severe-acute-manic-episodes-retrospective-prescription-practice-from-a-tertiary-inpatient-unit
#10
Armağan Özdemir, Cana Aksoy Poyraz, Burç Ç Poyraz, Nazife G Usta Sağlam, Semra Enginkaya, Nesrin Tomruk
OBJECTIVE: A retrospective chart review was performed to investigate the common preferences of clinicians for the pharmacological treatment of acute manic episodes, with particular regard to lithium use, and to assess the adherence of clinical practice to established guidelines. METHODS: Cases of manic episodes in patients admitted to Bakirköy Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital were retrospectively reviewed. Length of stay, medication data, serum levels, and adverse effects were evaluated for patients who received lithium therapy (N=98)...
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28492453/late-life
#11
John M Oldham
No abstract text is available yet for this article.
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28291043/repetitive-transcranial-magnetic-stimulation-and-treatment-emergent-mania-and-hypomania-a-review-of-the-literature
#12
Fady Rachid
BACKGROUND: This review focuses on treatment-emergent mania/hypomania (TEM) associated with repetitive transcranial magnetic stimulation (rTMS). METHODS: English-language studies involving possible rTMS-induced mania/hypomania published between 1966 and 2015 were retrieved through a Medline search using the search terms mania, hypomania, mixed affective state, treatment-emergent, repetitive transcranial magnetic stimulation, and rTMS. Fifteen case series and controlled studies describing TEM associated with rTMS treatment have been published involving 24 individuals, most of whom were diagnosed with either bipolar I or II disorder or major depressive disorder...
March 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28291042/commentary-transcranial-magnetic-stimulation-does-it-matter-where-or-what-or-whom-you-target
#13
Joshua Berman
Repetitive transcranial magnetic stimulation is a promising treatment for depression and possibly for other psychiatric disorders. Clinical trials show a small but significant benefit compared with sham treatment. Occasional patients respond dramatically, as witnessed in the 2 cases presented here of patients with depersonalization symptoms. The guest discussant, Dr Joshua Berman, analyzes the challenges of finding individualized treatment parameters that could make repetitive transcranial magnetic stimulation more predictably effective...
March 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28291041/treatment-of-a-patient-with-depersonalization-disorder-with-low-frequency-repetitive-transcranial-magnetic-stimulation-of-the-right-temporo-parietal-junction-in-a-private-practice-setting
#14
Fady Rachid
Depersonalization disorder (DPD) is a debilitating dissociative condition with no proven treatments. Although the pathophysiology of DPD is poorly understood, there are reports of increased excitability of the prefrontal cortex in patients with this condition. The temporo-parietal junction may also play a major role in the conscious experience of the spatial unity of the normal self and body. Repetitive transcranial magnetic stimulation has been shown in some case studies to effectively treat this condition...
March 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28291040/treatment-of-depersonalization-disorder-with-repetitive-transcranial-magnetic-stimulation
#15
Bianca C Karris, Marc Capobianco, Xin Wei, Lesley Ross
High frequency repetitive transcranial magnetic stimulation (rTMS) was approved by the US Food and Drug Administration in 2008 to treat major depressive disorder in those who did not respond to at least 1 antidepressant trial. Previous studies have shown that both high frequency rTMS to the left dorsolateral prefrontal cortex (DLPFC) and low frequency rTMS to the right DLPFC have antidepressant efficacy in treatment-resistant depression. Although rTMS has been widely used in the treatment of depression, very few studies of rTMS in patients with depersonalization disorder (DPD) have been published so far...
March 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28291039/performance-validity-testing-in-neuropsychology-scientific-basis-and-clinical-application-a-brief-review
#16
Michael R Greher, Thomas R Wodushek
Performance validity testing refers to neuropsychologists' methodology for determining whether neuropsychological test performances completed in the course of an evaluation are valid (ie, the results of true neurocognitive function) or invalid (ie, overly impacted by the patient's effort/engagement in testing). This determination relies upon the use of either standalone tests designed for this sole purpose, or specific scores/indicators embedded within traditional neuropsychological measures that have demonstrated this utility...
March 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28291038/psychotherapy-research-and-the-nimh-an-either-or-or-both-and-research-agenda
#17
Eric M Plakun
There is a need for psychotherapy research to determine the effective, nonspecific or shared elements of psychotherapy regardless of therapy school. In an apparent "either/or" rather than "both/and" choice, the National Institute of Mental Health (NIMH) has committed its research resources to study of neural mechanisms and biomarkers, while greatly reducing funding for research into clinical methods, including psychotherapy. This column explores the potential effect of this decision on patient care and reviews questions raised by some about whether the underlying "big idea" behind the NIMH research approach is supported by the results of several decades of brain and genomics research...
March 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28291037/tardive-dyskinesia-a-historical-perspective
#18
Matthew Macaluso, Alexandra Flynn, Sheldon H Preskorn
The goal of this column is to provide historical context on tardive dyskinesia (TD) to help the reader understand how the concept was studied and evolved over time. Psychiatrists today should understand this history and consider it in combination with more recent data on the neurobiology of TD, including data from animal studies. This combination of classic data with modern science can help readers develop a more complete understanding and lead to a more judicious use of the term TD, after consideration of all of the alternative causes of abnormal movements, including spontaneous dyskinesia (SD)...
March 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28291036/potential-mechanisms-of-hematological-adverse-drug-reactions-in-patients-receiving-clozapine-in-combination-with-proton-pump-inhibitors
#19
Michał Wiciński, Mateusz M Węclewicz, Mateusz Miętkiewicz, Bartosz Malinowski, Elżbieta Grześk, Joanna Klonowska
Clozapine is a second-generation antipsychotic which has proven efficacy in treating the symptoms of schizophrenia. Although clozapine therapy is associated with a number of adverse drug reactions, it is frequently used. One of the most common adverse drug reactions is gastroesophageal reflux disease which is an indication for treatment with proton pump inhibitors (PPIs). Coadministration of clozapine and PPIs increases the risk of hematological adverse drug reactions, including neutropenia and agranulocytosis...
March 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28291035/borderline-or-schizotypal-differential-psychodynamic-assessment-in-severe-personality-disorders
#20
Laura VAN Riel, Theo J M Ingenhoven, Quin D VAN Dam, Marike G Polak, Meinte G Vollema, Anne E Willems, Han Berghuis, Harold VAN Megen
Considerable overlap in symptoms between patients with borderline personality disorder (BPD) and schizotypal personality disorder (STPD) complicates personality diagnostics. Yet very little is known about the level of psychodynamic functioning of both personality disorders. Psychodynamic assessment procedures may specify personality characteristics relevant for differential diagnosis and treatment planning. In this cross-sectional study we explored the differences and similarities in level of personality functioning and psychodynamic features of patients with severe BPD or STPD...
March 2017: Journal of Psychiatric Practice
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