Psychologists have been researching suicide by various methods for many years with the intention to improve understanding of the reasons behind this act. The most recent research focuses on studying suicide notes that people left before their death. Suicide notes have been studied using many different methods. The most recent method is the theoretical-conceptual analysis, which investigates the most significant suicide theories and tries to identify them among suicide notes. Aside from the main motives behind the act of suicide, this method also tries to identify gender and age differences among people who committed suicide, as well as differences between suicide attempts and completed suicides. The possibility of generalizing the results of these studies is of great importance, as well as practical application with the intention of improving suicide prevention.
Background: Transplant psychiatry is a subspecialty of consultation-liaison psychiatry that focused on evaluation, treatment, and research of mental health problems in organ transplant recipients and organ donors. To date, there is no literature about training programs that would ensure psychiatrists acquire the necessary knowledge and skills required to meet the clinical needs of these patients. Objectives: The author describes the implementation of an online curriculum in transplant psychiatry created at the request of physicians located outside the United States. Method: A 3session online interactive course focused on knowledge relevant to transplant psychiatry was held in the fall of 2018. While the instructor was based in the United States, all attendees were located in Pakistan. The impact of the course was evaluated via precourse and postcourse surveys assessing knowledge level, interest in transplant psychiatry, and level of comfort with transplant psychiatry evaluations in the pretransplantation and posttransplantation settings. Results: Nine participants attended at least one of the 3 sessions, and 6 attended all 3 sessions. There were no significant events regarding the implementation of the curriculum. The response rate to the questionnaire was 100% before the course and 88.8% after the course. Precourse and postcourse tests indicated the curriculum had a positive impact on the level of knowledge and level of confidence in addressing problems relevant to transplant psychiatry. Conclusions: Online curriculum for highly specialized areas of psychiatry is feasible and can have a positive impact on knowledge levels and confidence in addressing clinical challenges.
Catatonia is a term first put forth by Karl Kahlbaum in his 1874 monograph, Die Katatonie oder das Spannungsirresein, in which he described patients experiencing a syndrome with prominent mood and motor abnormalities. The motor findings of immobility, stupor, rigidity, catalepsy, and negativism are typically the most commonly seen. Among the several catatonic symptoms identified, an important subset affecting speech exists: logorrhea, verbigeration, mutism, and echolalia. There is a dearth of literature regarding catatonia speech symptoms, and to our knowledge a specific type of catatonic speech symptom which we shall call “narration” has never been described before. In this paper, we present a case in which a man with bipolar disorder developed catatonia with prominent motor symptoms, and a peculiar speech symptom of narrating the sequence of events that he perceived around him. We will discuss the work up for his case and his management using benzodiazepines. The paper will also present a focused summary of the literature on catatonic speech symptoms. Our case is a reminder for clinicians to be aware of and observant for peculiar speech features of catatonia, as this can lead to consideration of effective treatment with benzodiazepines or ECT.
Background Nivolumab is an immune checkpoint inhibitor with indications for multiple malignancies. New reports of adverse events continue to emerge, including one Case report of nivolumab-associated akathisia. We describe a second case of likely nivolumab-induced akathisia. Case A 68-year-old female with metastatic renal cell carcinoma presented with restlessness that became acutely debilitating approximately fourth months after initiating treatment with nivolumab. Psychiatric evaluation revealed no psychiatric history and no current mood, anxiety, or psychotic symptoms. She had intermittently taken prochlorperazine as needed for nausea. An extensive medical workup was unrevealing for any cause of her symptoms. The clinical picture progressed to involve parkinsonian features in addition to the restlessness. Unfortunately all of the patient’s symptoms were refractory to typical treatments including benzodiazepines, propranolol, iron supplementation, carbidopa-levodopa, and ropinirole. After a four-week hospitalization with minimal improvement, she discharged home on hospice and passed away a month later. Discussion There is one prior Case report of nivolumab-induced debilitating akathisia. As with our case, that patient had severe akathisia unresponsive to numerous treatments. In both cases, no medication trial resulted in significant improvement and both patients died soon after developing akathisia. Conclusion The side effect profile of immune checkpoint inhibitors remains incompletely characterized. This is the second reported Case of treatment-resistant akathisia likely associated with nivolumab use and provides further context for future investigations into checkpoint inhibitor-induced neurotoxicities.
Background Selective serotonin reuptake inhibitors (SSRIs) are known to rarely cause extrapyramidal symptoms (EPS), including acute dystonia. The first treatment step for patients who suffer from drug induced acute dystonia is discontinuation of the offending agent. In addition, many patients require acute treatment using antimuscarinic or antihistamine agents. Case description We present the case of Ms. T, a 33 year old woman with generalized anxiety disorder who developed cervical dystonia one month after starting escitalopram which was persistent despite treatment. Due to the lack of treatment response, functional neurological symptom disorder was considered. Ms. T ultimately responded to deutetrabenazine, a medication typically used to treat tardive dyskinesia. Conclusion and Discussion: Despite initially being diagnosed with SSRI induced acute dystonia, Ms. T’s time course and treatment response did not fit well with this diagnosis. Ms. T ultimately received a diagnosis of SSRI induced tardive dystonia, though a functional disorder may have also contributed to her symptoms. This Case demonstrates the importance of a comprehensive workup in atypical dystonic reactions and a trial of all available pharmacological interventions. While deutetrabenazine is typically considered a treatment for tardive dyskinesia, other tardive syndromes, including tardive dystonia, may respond well to this treatment.
Capacity requests in the general hospital require the consultation-liaison (CL) psychiatrist to make assessments based on their evaluation of the patient’s ability to understand and make informed choices, as well as consideration of the clinical situation. When a patient does not have capacity to consent for surgery and the intervention is non-urgent, the ramifications of treating over objection must be considered carefully. We present a case of a patient with schizophrenia who refused a non-urgent surgical intervention to repair a cervical spine injury. We discuss important factors that impact medical decision-making in the general hospital. In this case, we give an example of how the interests of the surrogate medical decision maker and hospital may conflict with the patient’s authenticity and how this can complicate the capacity assessment, decision-making process, and hospital course. An ethics committee was utilized to discuss the risks and benefits of treating over objection and implications for the patient and care team.
Background: Wernicke-Korsakoff Syndrome (WKS) resulting from thiamine deficiency is classically defined as including encephalopathy, ataxia, and ophthalmoplegia. Only 16% of autopsy-confirmed patients with WKS exhibit all three signs. Caine positive WKS criteria include two or more of the following: nutritional deficiency, delirium or mild memory impairment, cerebellar dysfunctionlataxia, and oculomotor abnormalities. Objective: We describe Caine positive WKS prevalence among psychiatric inpatients and compare pretreatment-versusposttreatment neurocognitive improvement to an unaffected group. Methods: This 6-month quality-improvement evaluation included two-stage screening for Caine positiveWKS, administering high-dose intravenous thiamine (day 1: 1200 mg; days 2-4: 200 mg) with reexamination on day 5. We used descriptive statistics and fitted random effects models to examine rate-of-change differences in pre-/posttreatment Montreal Cognitive Assessment (MoCA), delayed 5-item recall, and gait/coordination scores between treated Caine positive patients with WKS and untreated Caine-negative patients. Results: Of 262 patients, 32 (12%) had Caine-positive WKS; 17 (53%) used alcohol currently. Treated Caine-positive WKS (n = 26) versus Caine-negative comparison (n = 34) before and after treatment observed a mean change (standard deviation) in the MoCA score of 3.6 (2.5) versus 1.8 (2.5) (P < 0.01); 5-item recall: 1.8 (1.4) versus 0.5 (1.4) (P < 0.001); gait/coordination scores: -0.6 (1.2) versus -0.1 (0.6) (P < 0.001). Oculomotor abnormalities were infrequent (n = 4 in Caine-positive WKS, n = 2 in Caine-negative comparison groups). Conclusions: Caine-positive WKS prevalence among psychiatric inpatients was 12%; only half used alcohol. Patients treated with high-dose thiamine demonstrated clinically significant neurocognitive improvement.
Background A growing literature documents psychological distress related to the novel coronavirus (COVID-19 or SARS-CoV2) pandemic. Method We describe new-onset psychotic symptoms in three patients with no prior history of psychosis who tested positive in the Emergency Department for COVID-19 and who were otherwise asymptomatic. Results Patients had similar presentations of agitation, disorganization, paranoid ideation and auditory hallucinations, with concurrent evidence of systemic inflammation as indicated by elevated C-reactive protein and other inflammatory markers. Conclusion In addition to the possibility of a stress-related trigger, based on evidence of immune activation, we postulate a potential immune-mediated neuropsychiatric trigger to these new-onset psychotic symptoms that warrants further investigation.
Treatment of catatonia in children and adolescents presents particular challenges due to the limited availability of electroconvulsive therapy (ECT) for minors. Evidence regarding pharmacological interventions for catatonia in the pediatric population remains limited. In this case report, we describe a 15-year-old boy with catatonia and autism in whom amantadine augmentation was successfully used to allow for transition to outpatient care. A review of the literature on the use of amantadine in the treatment of pediatric catatonia was conducted and summarized with special consideration of patients with co-morbid autism spectrum disorder.
