OBJECTIVE:To describe a case of biopsy-confirmed lymphocytic microscopic colitis (MC) temporally associated with paroxetine (Paxil) therapy and to highlight psychiatric nursing implications for monitoring serotonergic adverse effects across the brain-gut interface. METHODS:This case report was developed using clinical history, diagnostic findings, treatment course, and relevant literature on selective serotonin reuptake inhibitors, MC, and serotonergic signaling in gastrointestinal function. RESULTS:A 27-year-old male with generalized anxiety disorder, panic disorder, agoraphobia, and irritable bowel syndrome developed chronic watery diarrhea, abdominal pain, bowel urgency, and one episode of fecal incontinence while receiving paroxetine, which had previously produced sustained psychiatric remission. Differential considerations included an irritable bowel syndrome flare, infectious diarrhea, inflammatory bowel disease, medication-associated diarrhea, and medication-associated microscopic colitis. Colonoscopy with biopsy confirmed lymphocytic MC. Paroxetine was discontinued, and the patient was treated with budesonide (Entocort EC) and adjunctive gastrointestinal therapies, leading to resolution of gastrointestinal symptoms. After recurrence of anxiety and panic symptoms and poor tolerability or inadequate response to alternative psychotropic medications, paroxetine extended-release was cautiously reintroduced with interdisciplinary monitoring. Gastrointestinal symptoms did not recur during the 1-year follow-up period. CONCLUSIONS:This case illustrates the importance of psychiatric nursing vigilance for persistent gastrointestinal symptoms in patients receiving serotonergic antidepressants. Recognition of possible medication-associated MC may support timely referral, interdisciplinary collaboration, and individualized psychopharmacologic decision-making.
BACKGROUND:Suicide is a leading cause of adolescent death in the United States (US), with access to lethal means significantly increasing mortality risk. Parents are crucial to prevention but often lack knowledge and confidence in lethal means restriction (LMR). Despite evidence-based support and national guidelines, LMR counseling remains inconsistently implemented in outpatient settings. PURPOSE:This project evaluated the feasibility, acceptability, and impact of the Lock and Protect (L&P) online decision aid in an outpatient mental health clinic, examining parent-reported changes in lethal means storage practices. METHODS:A 12-week quality improvement project was conducted in a suburban southeastern US outpatient mental health clinic. Parents and guardians of adolescents accessed the L&P decision aid via QR-code flyers during visits or through electronic health record portal messages. Participants completed anonymous surveys assessing the tool's usefulness, approachability, relevance, and planned storage practice changes. Descriptive statistics were used to analyze responses. RESULTS:Of 165 families invited, 31 completed surveys (18.8%), with in-person QR-code distribution yielding higher engagement than electronic messaging. Most participants found the tool useful (83.9%) and reported that it made discussing this difficult topic more approachable (90%). Overall, 67.7% planned to change the storage of at least one lethal means type, most commonly medications (43.3%). Among families with unsecured firearms, 66% planned to adopt more secure storage practices. CONCLUSION:Used in an outpatient mental health setting, the L&P decision aid demonstrated utility, approachability, and relevance with increased intent to secure lethal means. Findings support this LMR education as a scalable, low-burden suicide prevention strategy appropriate for outpatient practice.
Background: In 2023, suicide emerged as the second leading cause of death for 10- to 24-year-olds in the United States, accounting for over 40,000 deaths across the age group. Recent research identified childhood adverse experiences, including sexual, physical, and emotional abuse and neglect, as possible links with youth suicidal behavior. Aims: This review aimed to synthesize qualitative evidence on childhood sexual abuse (CSA) and the relationship to self-harm, suicidal ideation, or attempts. Methods: CINAHL, OVID Medline, and PsycInfo databases were searched for qualitative research articles relevant to youth sexual abuse, trauma, and suicidal behaviors. Results: Of 442 records screened, 11 qualitative studies met the criteria for the systematic review. Four themes emerged: CSA and the perpetrators; suicidal behaviors and self-harm; shame, self-blame, and guilt; and disclosure. Conclusions: Despite the growing prevalence of childhood sexual abuse and other traumas, there is a lack of boundaries and safety for youth and an absence of effective strategies to mitigate CSA and related suicidality. Opportunities for youth disclosure about child sexual abuse initiate the work of healing from shame and should be provided in a timely manner. Researchers acknowledge the powerful impact of disclosure and advise ongoing therapy for recovery, with emphasis on safe environments.
Objective: Within the United States, suicide ranks as the second leading cause of death among the adolescent population, with continual increases projected in the future. Ultimately, much research focuses on depression and anxiety in adolescents; however, little focus has been given to the concept of fear and its role as a precursor to suicidal ideation and attempt. The concept of fear is the focus of this concept analysis to further understand its role in adolescent suicide. Methods: For this concept analysis, Walker and Avant’s method was utilized to review and thoroughly examine the concept of fear. The Standards for Reporting Qualitative Research (SRQR) guideline is followed. Results: Utilizing specific criteria in narrowing the search, a total of 43 articles were reviewed to identify attributes of the concept fear. After reviewing the literature to identify all possible uses of the concept, such as fear of disclosure, fear of negative evaluation, fear of social exclusion, fear of cultural consequences, and fear in outside contexts, defining attributes consist of dread, stigma, and exclusion. Cases are further examined to show a model, related, contrary, and borderline case. Antecedents, both psychosocial and systemic, are reviewed and established as bullying, social rejection from peers, familial response, perceptions of providers, and gaps in consistent screening. Consequences may cause an adolescent to underreport symptoms or withdraw, leading to potential suicidal ideation and attempt. Conclusions: Ultimately, utilizing routine universal suicide screening and close monitoring within healthcare settings may be the key to reducing fear and preventing adolescent suicide.
BACKGROUND:Preceptors are vital in shaping the clinical education of psychiatric and mental health nurse practitioners (PMHNPs). A shortage of behavioral health providers has led to calls for increased capacity in PMHNP programs. Growing competition for sites and concerns for the recruitment and retention of qualified preceptors mean fewer placements. AIMS:The purpose of this study was to identify motivations and barriers that current PMHNPs encounter when deciding to precept students. In addition, we aimed to analyze the relationship between demographic variables and the likelihood of precepting. METHODS:The investigators developed and administered an online survey to collect demographic and other qualitative and quantitative data from 93 currently practicing PMHNPs, recruited via professional networks, nursing associations, and social media platforms. Data were analyzed in Qualtrics, and results were reported using descriptive statistics. RESULTS:Common motivational themes include contributing to the future of the profession, mentorship, teaching, and maintaining a connection to academic faculty and institutions. Frequently cited challenges associated with precepting responsibilities included time constraints, competing clinical demands, paperwork and administrative burden, student professionalism, and lack of compensation for precepting work. CONCLUSION:Findings revealed a framework for creating incentives for precepting, including university perks, title, recognition, access, appreciation, organizational discounts, and a built-in compensation structure, with time reported as being most valuable. We developed an enhanced understanding and identified ways to improve the recruitment and retention of qualified preceptors in this field.
BACKGROUND:Methylphenidate is a first-line psychostimulant widely prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD). Although its therapeutic efficacy is well established, concerns remain regarding its potential effects on cardiovascular regulation, particularly on autonomic nervous system balance. AIMS:To evaluate the effect of methylphenidate on heart rate variability (HRV) in ADHD children and adolescents. METHODS:Our review included children and adolescents diagnosed with ADHD, studies wherein the intervention group should receive short- or long-term methylphenidate treatment, studies that evaluated participants under conventional treatment except methylphenidate, single or double-blind, non-blind randomized or non-randomized control studies. RESULTS:No significant changes were observed in time- and frequency-domain HRV indices, with all outcomes presenting very low certainty of evidence. CONCLUSIONS:Our results indicate that methylphenidate does not significantly affect resting heart rate HRV in ADHD children and adolescents. The very low certainty of this review's evidence level and high risk of bias warrant further studies to provide stronger scientific and statistical evidence.
BACKGROUND:Adolescents with attention-deficit/hyperactivity disorder (ADHD) often require long-acting or pro-drug stimulants, but telehealth prescribing is constrained by the Ryan Haight Act's in-person requirements. While pandemic-era waivers temporarily lifted these mandates, their permanent status remains uncertain. AIMS:Assess long-acting or pro-drug stimulant medication adherence using proportion of days covered (PDC) in adolescents with ADHD (12-17) receiving telehealth or hybrid care (2022-2024), comparing rates to post-pandemic (April 2020-June 2022) adherence rates in urban pediatric populations. Examine symptom scores on the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Screening (GAD-2), and ADHD Symptom and Side Effect Tracking (ASSET). Compare visit attendance between telehealth and hybrid care. METHODS:Program evaluation consisting of retrospective chart reviews, pre-visit surveys, and prescription data on 49 adolescents (21 telehealth and 28 hybrid) in a psychiatric clinic were evaluated. RESULTS:The total sample mean PDC was .381. Hybrid group adherence was .448 and .313 for the telehealth group. PDC was the same as the post-pandemic adherence rate (.310-.440). Paired t-tests comparing GAD-2 scores were (p < .001), PHQ-9 (p < .001), and ASSET (p = .010). Telehealth attendance was lower than hybrid attendance. CONCLUSIONS:The hybrid care model showed better adherence and attendance than telehealth for adolescents with ADHD. PDC from this program evaluation was statistically similar to national trends in pediatric ADHD management. Future research must prioritize geographic and digital determinants, understand the impact of polypharmacy, and establish evidence-based strategies to enhance long-term adherence in telehealth care models.
Objective: This discussion paper explores the intersection of cultural factors and Black women’s experiences with chronic pain and suicidality. It aims to inform the continued development of tailored pain interventions and culturally responsive psychiatric nursing care. Methods: Using existing literature, we identified six domains of cultural factors potentially influencing Black women’s pain experiences and suicide risk. The six domains were conceptually organized into two categories: culturally specific risk factors and culturally specific protective factors. Results: In terms of risk factors, the endorsement of the superwoman schema, intersectionality, and history of medical mistrust were identified. For protective factors, spirituality, culture, and reliance on social support were identified. Conclusions: Drawing on the disciplines of African American Studies, Black Psychology, and Clinical Health Psychology, we provide clear recommendations for the development of culturally tailored interventions that can uniquely address Black women’s pain and suicide-related experiences while receiving psychiatric nursing care.
OBJECTIVE:This article describes the federal Medicaid Institutions for Mental Diseases (IMD) exclusion and compares legislative proposals introduced in the 119th Congress-House of Representatives Bill (H.R.) 5662 and H.R. 6727-that seek to repeal this policy. METHODS:A descriptive policy analysis was conducted using publicly available legislative texts, related federal policy documents, and earlier reviews examining potential impacts of the repeal of the IMD exclusion. The analysis summarizes the statutory basis of the IMD exclusion, reviews existing workarounds, and compares the key mechanisms proposed in H.R. 5662 and H.R. 6727. Potential implications for Medicaid financing and inpatient psychiatric capacity are discussed. RESULTS:The IMD exclusion prohibits federal Medicaid reimbursement for most inpatient psychiatric facilities with more than 16 beds for adults aged 21-64 years, contributing to reliance on state financing and temporary waiver programs. Both H.R. 5662 and H.R. 6727 propose repealing this exclusion. H.R. 5662 would repeal the policy without additional requirements, while H.R. 6727 would also require the U.S. Department of Health and Human Services to establish standards for participating facilities. Repeal would expand eligibility for federal Medicaid funding but would not mandate changes in state utilization or capacity. CONCLUSIONS:Recent legislative efforts to repeal the IMD exclusion reflect a growing concern regarding inpatient psychiatric bed shortages and mental health system strain. Understanding the differences between proposed repeal strategies is essential for evaluating how changes in Medicaid financing could affect inpatient psychiatric care and broader behavioral health systems.
BACKGROUND:Alcohol withdrawal is a prevalent challenge to manage in the hospital setting, and left undetected, can lead to life-threatening outcomes. Early identification and intervention are critical to improve morbidity and mortality. Nurses are the primary users of withdrawal assessment instruments in the hospital setting, and recommendations are needed regarding assessment tools that are psychometrically sound and usable. AIMS:The purpose of this integrative review was to evaluate and summarize the evidence related to the psychometric testing and usability of alcohol withdrawal assessment tools used in the hospital setting. METHODS:The Whittemore & Knafl method was used to conduct the review including the following stages: problem identification, literature search, data evaluation, data analysis and presentation of findings. Inclusion criteria were (a) developed/tested in an English-speaking country, (b) used in an adult population, (c) used in a hospital environment, (d) designed to screen or assess for alcohol withdrawal, and (e) tested for reliability, validity, and/or usability. RESULTS:A total of 17 articles were identified that tested 14 instruments, ranging from 1 to 18 items. Studies were conducted in the United States (n = 7), Europe (n = 4), Canada (n =4), and Australia (n = 1). Validity was evaluated in the highest number of studies (n = 14), followed by reliability (n = 9), and usability (n = 9). CONCLUSIONS:This review comprehensively examined reliability, validity, and usability findings of 14 instruments used for the assessment of alcohol withdrawal in the hospital setting. Findings can be used to help inform instrument selection based on psychometric properties and clinical application.
OBJECTIVE:To summarize the impact of the rise in Telemental Health (TMH) utilization on psychiatric mental health nurse practitioner (PMHNP) practice and education, and to present direction for PMHNP educators on emerging competencies and lessons learned from evolving TMH curricula. METHODS:This discussion paper updates the PMHNP educational environment in the context of the postpandemic rise in TMH and concurrent changes in educational guidelines from the American Association of Colleges of Nursing (AACN) and National Organization of Nurse Practitioner Faculties (NONPF). The integration of telehealth content into nurse practitioner (NP) curricula is presented along with the evolution of one PMHNP program's TMH curriculum from 2019 to 2025. Future directions and recommendations for action for PMHNP educators and practitioners are shared. RESULTS:TMH is here to stay, is well accepted by patients and providers, and holds the potential to improve access to care. Integrating TMH across curricula necessitates the consideration of the unique practice nuances of the discipline of PMH and further study of outcomes. CONCLUSION:Integrating competency-based TMH education across the curriculum through didactic, simulation, and clinical experiences, and studying and refining existing TMH content, will ensure the future PMHNP workforce is prepared to deliver safe, legal, and effective care to a broader patient population.
BACKGROUND:This study examined how the presence of psychotic symptoms affects police decision-making during behavioral health crisis interventions, with a focus on outcomes of jail diversion, emergency department (ED) diversion, and involuntary hold. AIMS:This study aimed to compare intervention patterns for individuals with and without psychotic presentations and to identify demographic, clinical, and operational factors associated with outcomes across groups. METHODS:A retrospective analysis of 50,062 police-led crisis encounters recorded in the Massachusetts Department of Mental Health's jail diversion program database between April 2023 and January 2025 was conducted, using stratified mixed-effects logistic regression with program location as a random effect. RESULTS:Psychosis was present in 22.8% of all encounters and was associated with similar rates of jail diversion (87.9% vs. 84.7%) and ED diversion (43.1% vs. 54.3%), and higher rates of involuntary hold (26.1% vs. 11.5%). Assessment in home or community settings was associated with increased ED diversion across populations, while the presence of on-scene emergency or support personnel predicted involuntary hold. Among those with psychosis, charge severity, referral source, and prior police contact were associated with jail diversion, while mood disorder had a stronger association with involuntary hold in the non-psychosis group. CONCLUSIONS:Findings highlight the need for population-specific crisis response protocols that integrate clinical features, setting, and referral dynamics. Structured decision-making tools, co-response models, and expanded consultation roles for mental health professionals, including psychiatric nurses, may improve alignment between individual needs and intervention outcomes.
BACKGROUND:Adolescent self-injurious behaviors (SIBs) present a global public health concern. Nurses, as frontline caregivers, play a crucial role in managing these cases, where their perceptions influence care quality. However, qualitative research deeply exploring these perceptions, particularly in the Zanjan, Iran context, remains scarce. AIMS:To explore the perceptions and experiences of Zanjan nurses caring for adolescents with SIB. METHODS:A qualitative content analysis study. Twelve nurses from general and psychiatric hospitals in Zanjan were purposively sampled. Data from in-depth, semi-structured interviews in Farsi were analyzed using the Graneheim and Lundman approach with MAXQDA software. RESULTS:Analysis of the data generated 449 initial codes, from which three main categories emerged: (1) Conceptualizing Self-Harm: A Spectrum from Distress to Crisis, encompassing subthemes of persistent mental rumination, perceived precipitating factors, and profound emotional impact; (2) Systemic and Clinical Challenges in Care Delivery, comprising subthemes of organizational barriers, care complexities, and limitations in available treatments; and (3) Emotional and Cognitive Responses to the Adolescent, including subthemes of attributions about the person, perceptions of psychological suffering, and recognition of familial struggles. CONCLUSION:Nurses' perceptions ranged from empathy to frustration. Notably, they often conceptualized non-suicidal self-injury and suicidal behaviors as interconnected expressions of distress rather than distinct phenomena. The findings highlight an urgent need for specialized nurse education, institutional support, and interdisciplinary collaboration to improve care. While insightful, the study's focus on one Zanjan province and a small sample size suggests cautious interpretation and indicates a need for broader research.
BACKGROUND:People with experiences of homelessness are at higher risk for suicide-related thoughts, behaviors, and deaths by suicide compared to those without homeless experience. This complex risk can be tied in part to extreme social need and multimorbidity. To meet these needs and reduce this risk, people with experiences of homelessness frequently require care from multiple providers. Continuity of care is protective against suicide risk, with care coordination playing a central role. Despite the importance of continuity of care in suicide prevention and the potential for mental health nurses to provide care coordination, few studies have explored this potential in relation to people with experiences of homelessness. OBJECTIVE:Provide a potential practice application to illustrate the possible value of using the Alberta Continuity of Services Scale for Mental Health (ACSS-MH) to measure and improve continuity of care as an important element of suicide prevention for people with experiences of homelessness. METHODS:Using the U.S. Department of Veteran Affairs (VA) Homeless Patient-Aligned Care Team (HPACT) model and universal VA suicide risk screening protocol as a practice exemplar, we discuss the ACSS-MH subscales to illustrate a potential care delivery evaluation and way the psychiatric nursing community can optimize continuity of care, suicide risk detection and suicide prevention in this population. RESULTS:Innovative screening and practice models are needed to effectively prevent suicide in high-risk populations, like people with experiences of homelessness. This case study provides insight into the ACSS-MH measure and VA-based homeless-specific primary care as an example of how psychiatric nurses could similarly use this measure to impact the safety of patients with experiences of homelessness by intentionally fostering continuity related to suicide prevention. CONCLUSIONS:This discussion of a practice application shows how the use of a validated measurement tool could drive quality improvement and research that begins with the measurement of continuity related to suicide prevention for high-risk populations.
