BackgroundIn the current digital age, individuals often look to the widely used social media application “TikTok” to obtain information about autism spectrum disorder (ASD). Despite this, no studies have evaluated the quality of information available about ASD on the app. Our aim was to investigate the understandability, actionability, and usefulness of TikTok videos about ASD.MethodsTo evaluate video quality, 100 videos tagged with “autism spectrum disorder” were obtained from TikTok between June 19th-21st, 2023. Videos were included if they pertained to ASD and excluded if they were not in English, unrelated to ASD, or duplicates. Two systems were used to assess the videos. The Patient Education Materials Assessment Tool for Audio- Visual Materials (PEMAT-A/V) was used to obtain percentage scores for video understandability and actionability. The videos were also sorted into one of three categories: useful, personal experience, or misleading (UPM). The assignment was based on if they contained factual information, anecdotal personal experiences, or incorrect information, respectively.ResultsOf the 100 videos analyzed, 24% were classified as useful; 36% as personal experience; and 40% as misleading. They had a mean PEMAT-A/V understandability score of 60.1% (SD=14.5, range=31.0-91.7%) and a median PEMAT-A/V actionability score of 0% (IQR=0-0, range=0-100%). The breakdown of topics discussed in the videos were as follows: 62% of videos discussed the diagnosis/symptoms of ASD, 17% pertained to disorder management, 7% gave an overview of the disorder as a whole, 2% discussed the cause of ASD, and 7% contained information classified as “other”. The majority of the videos were made by non-HCPs (86%), while the remaining videos were made by HCPs (14%). HCPs uploaded a significantly higher percentage of useful content (50%) than non-HCPs (20%, p=0.034). HCPs also uploaded a significantly higher percentage of Diagnosis/Symptoms content (85.7%) than non-HCPs (62%, p=0.015).ConclusionTikTok content about ASD is of unsatisfactory quality. Overall, videos are of moderate understandability, very low actionability, and are often misleading. Individuals should exercise caution when browsing the app for information about ASD, and HCPs should be aware that patients are likely to have been exposed to confusing or misleading information.

Objective:Compared to the general population, the risk of suicide is three times higher in patients with epilepsy and remains doubled for these patients even after adjusting for sociodemographic correlates of suicide in the absence of mental health comorbidities. Following the United States (US) Food and Drug Administration (FDA) alert prompting a black box warning regarding the association between suicidality and antiepileptic drugs (AEDs), several studies were conducted, the results of which have been ambiguous, with some demonstrating a positive association between suicidality and AEDs, while others did not. This systematic review of literature sought to study the relationship between suicidality and AEDs when used exclusively for treatment of epilepsy.Methods:A comprehensive literature search was conducted on PubMed without time limits using a predefined search language. The search results were then subjected to a systematic screening process. Eight out of a total of 443 articles satisfying predefined inclusion and exclusion criteria were included in the review for final data extraction.Results:Three studies found a significant association between suicide-related behavior and levetiracetam use in the treatment of epilepsy. One study reported a positive association of pregabalin use in patients with epilepsy under 40 years of age and high AED load with suicidality, independent of depression. The remaining four studies reported a significant association between positive family and personal history of psychiatric comorbidities and suicidality in epilepsy.Conclusion:Although there were several methodological limitations, this review found an association between levetiracetam use and mental health comorbidities and the occurrence of suicidality in epilepsy. Larger prospective, randomized studies that overcome the limitations of current studies are required to provide definitive evidence on the occurrence of suicidality in patients with epilepsy and AED use.

The concept of the "Dorian Gray Trait," inspired by Oscar Wilde's renowned literary work, delves into the intricate interplay between self-perception, the fear of aging, and the pursuit of eternal youth. This article explores the psychological dimensions of this trait, wherein individuals harbor an intense preoccupation with maintaining their youthful appearance, often at the cost of their overall well-being. By examining the underlying factors that drive this phenomenon, including societal pressures and personal anxieties, we aim to shed light on the broader implications for mental health and self-image.

Tourette's syndrome (TS) patients experiencing severe tics and behavioral disturbances can have a rare complication called rhabdomyolysis (RML), which is characterized by the breakdown of muscle tissue. The occurrence of RML poses a significant physical and emotional risk to patients with TS by impacting the quality of life and in some cases causing severe damage. In this case report, we present the first documented case of RML resulting from severe tics in an adult with a diagnosis of TS. The patient exhibited severe tics and self-injurious behaviors that led to elevated creatine kinase and a subsequent diagnosis of RML requiring hospitalization with a complex hospital course. The patient did not have neuroleptic malignant syndrome as his laboratory parameters improved with the decrease in severity of tics. Our case highlights the potential complication of RML because of severe tics independent of neuroleptic drug use in a patient with TS.

Observing cataplexy episodes during an office visit is extremely rare as they are usually triggered by laughter or emotional stress. Narcolepsy usually occurs in the younger population. We report a case of a 65-year-old Caucasian female with a past medical history of obesity who developed excessive daytime sleepiness, fatigue, and sleep attacks five weeks after getting influenza and pneumococcal vaccines. The presentation of cataplexy was atypical. Several episodes of cataplexy were observed during the office visit without any emotional trigger. Further workup, including polysomnography (PSG), was positive for obstructive sleep apnea, controlled with continuous positive airway pressure (CPAP) use. Later, she had PSG with CPAP use, which optimally controlled obstructive sleep apnea, followed by multiple sleep latency tests (MSLT) with CPAP use. It was positive for narcolepsy with a mean sleep latency of 1.6 minutes with sleep onset rapid eye movement (REM) in five out of five naps. Her cerebrospinal fluid (CSF) hypocretin level was extremely low at 50 pg/ml, usually seen in narcolepsy with cataplexy. She was also positive for human leukocyte antigen (HLA) DBQ1*06:02. The diagnosis of narcolepsy with cataplexy was made, which improved with medications for narcolepsy.

Objective: To assess the efficacy, safety, and tolerability of topiramate for the treatment of posttraumatic stress disorder (PTSD) in civilians.Methods: This 12-week double-blind, randomized, placebo-controlled study enrolled 72 outpatients (aged 19-64 years) with a DSM-IV-TR diagnosis of non-combat-related PTSD and a score ≥ 50 on the Clinician-Administered PTSD Scale (CAPS). The primary efficacy endpoint, percent change in total CAPS score, and secondary efficacy measures were assessed by analysis of covariance. Safety assessments included monitoring of vital signs, physical examinations, clinical laboratory parameters, electrocardiograms, and adverse events (AEs). The study was conducted from October 2001 to March 2004.Results: The intent-to-treat (ITT) population (N = 68; mean age = 35 years; 87% women; 74% White) showed greater percent reduction in total CAPS scores with topiramate versus placebo (39.5% vs 29.5%), but the difference was not statistically significant (P = .31). Similarly, higher reductions with topiramate versus placebo were seen in the CAPS subscale scores for symptoms of reexperiencing (43.6% vs 34.8%), avoidance/numbing (38.3% vs 30.6%), and hyperarousal (36.6% vs 21.4%). However, these differences were not statistically significant. Six patients in the topiramate arm had a final CAPS score < 20, whereas only 2 in the placebo arm achieved the result (P = .075). The median final topiramate daily dose was 100 mg/d (range, 25-400 mg/d), and mean ± SD treatment duration was 55 ± 32 days, showing the tolerability of the medication. In topiramate-treated patients, treatment-emergent AEs included paresthesia, headache, fatigue, and insomnia; treatment-limiting AEs included influenza-like symptoms, agitation, cognitive problems not otherwise specified, and somnolence. However, a higher rate of AE-related discontinuation was seen in the placebo group than in the treatment group (26% vs 18%).Conclusions: In this 12-week civilian PTSD study, topiramate improved the primary and secondary outcome measures at a higher rate than did placebo, but the difference did not reach statistical significance. Further adequately powered studies may be warranted.Trial Registration: Clinical Trials.gov identifier: NCT00208130.Prim Care Companion CNS Disord 2023;25(5):23m03555. Author affiliations are listed at the end of this article.

As artificial intelligence (AI) continues to evolve and mature, it is increasingly finding applications in the field of healthcare, particularly in specialties like radiology that are data-heavy and image-focused. Language learning models (LLMs) such as OpenAI's Generative Pre-trained Transformer-4 (GPT-4) are new in the field of medicine and there is a paucity of literature regarding the possible utilities of GPT-4 given its novelty. We aim to present an in-depth exploration of the role of GPT-4, an advanced language model, in radiology. Giving the GPT-4 model prompts for generating reports, template generation, enhancing clinical decision-making, and suggesting captivating titles for research articles, patient communication, and education, can occasionally be quite generic, and at times, it may present factually incorrect content, which could lead to errors. The responses were then analyzed in detail regarding their potential utility in day-to-day radiologist workflow, patient education, and research processes. Further research is required to evaluate LLMs' accuracy and safety in clinical practice and to develop comprehensive guidelines for their implementation.

Serotonin syndrome, also known as serotonin toxicity, is associated with increased serotonergic activity in the central and the peripheral nervous system. The symptoms can range from mild to potentially life threatening. Given the widespread use of serotonergic agents, the number of cases is on the rise. It is seen with therapeutic medication use, inadvertent interactions between drugs, and intentional self-poisoning, but still known cases with monotherapy of selective serotonin reuptake inhibitors are uncommon. Another known fact is that elevated whole blood serotonin, or hyperserotonemia, is one of the first biomarkers identified in autism spectrum disorder and is present in more than 25% of affected children. We present a case of a 32-year-old male with a history of autism spectrum disorder and depressive disorder who presented to the emergency department with restless agitation, neuromuscular excitability, and autonomic instability. He had been prescribed sertraline 50 mg which he had taken daily as prescribed for 4 days. On the fourth day, he presented to the emergency department with diffuse muscle stiffness, upper extremity tremors, ocular clonus, and inducible ankle clonus. He was diagnosed with probable serotonin syndrome utilizing Hunter's criteria. Patient's symptoms resolved within 24 hours with intravenous fluids, lorazepam, and discontinuation of sertraline. This case highlights the importance of a high degree of clinical suspicion in patients even on monotherapy of selective serotonin reuptake inhibitors in therapeutic doses, especially in children and adults with autism spectrum disorder. Due to preexisting hyperserotonemia, they may be more susceptible to serotonin syndrome than the general population.

ObjectiveTo determine the efficacy, safety, and tolerability of vilazodone in the treatment of posttraumatic stress disorder (PTSD) with comorbid mild-to-moderate depression.MethodsA 12-week randomized, double-blind, placebo-controlled trial was conducted in adult outpatients who met DSM-IV criteria for PTSD with comorbid depression between February 2013 and September 2015. Participants were randomly assigned to receive vilazodone 40 mg/d or placebo, and outcome measures were obtained at scheduled visits. Primary outcome measures included change in PTSD symptoms from baseline to end of study as indexed by the Clinician-Administered PTSD Scale (CAPS) and PTSD Symptom Scale-Self-Report (PSS-SR). Secondary outcome measures of anxiety, depression, and impairment were obtained, as well as biomarker assessment at baseline and end of study.ResultsA total of 59 patients were randomly assigned to receive vilazodone (n = 29) or placebo (n = 30). Of those who were randomized, there were 25 completers in the vilazodone group and 22 completers in the placebo group. No significant differences were observed between the groups on any of the primary or secondary outcome measures. Vilazodone was generally well tolerated with few differences in the rate of adverse events between groups.ConclusionsTreatment with vilazodone 40 mg/d did not improve symptoms of PTSD and comorbid depression. Further investigation of the biological mechanisms underlying PTSD may lead to identification of improved therapeutic targets.Trial RegistrationClinicalTrials.gov identifier: NCT01715519.

OBJECTIVE Apathy is a common behavioral problem in Alzheimer's disease. Apathy has profound consequences, such as functional impairment, higher service utilization, higher caregiver burden, and increased mortality. The authors' objective was to study the effects of methylphenidate on apathy in Alzheimer's disease. METHOD A 12-week, prospective, double-blind, randomized, placebo-controlled trial (methylphenidate versus placebo) was conducted in community-dwelling veterans (N=60) with mild Alzheimer's disease. The primary outcome for apathy (Apathy Evaluation Scale-Clinician) and secondary outcomes for cognition (Mini-Mental State Examination, Modified Mini-Mental State Examination), functional status (activities of daily living, instrumental activities of daily living), improvement and severity (Clinical Global Impressions Scale [CGI]), caregiver burden (Zarit Burden Scale), and depression (Cornell Scale for Depression in Dementia) were measured at baseline and at 4, 8, and 12 weeks. RESULTS Participants were all men (77 years old, SD=8). After adjusting for baseline, the methylphenidate group had significantly greater improvement in apathy than the placebo group at 4 weeks, 8 weeks, and 12 weeks. At 12 weeks, there was also greater improvement in cognition, functional status, caregiver burden, CGI scores, and depression in the methylphenidate group compared with the placebo group. CONCLUSIONS Methylphenidate improved apathy in a group of community-dwelling veterans with mild Alzheimer's disease. Methylphenidate also improved cognition, functional status, caregiver burden, CGI scores, and depression.

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.To the Editor: Osmotic demyelination syndrome is a feared complication of rapid correction of hyponatremia. While central pontine myelinosis is a well-known complication of rapid correction of chronic hyponatremia, physicians should be aware that myelinosis can occur outside the pons as well. The presence of extrapontine myelinosis resulting from osmotic demyelination has been detected during autopsy in up to 80% of demyelination cases.

OBJECTIVE The objective of this article is to present a case of improved outcome of apathy syndrome with aripiprazole. CASE SUMMARY A 42-year-old man with depression and seizure disorder had significant apathy that did not respond to carbamazepine, sertraline, and topiramate. Apathy was assessed using Apathy Evaluation Scale. Discontinuation of carbamazepine did not alleviate apathy. Aripiprazole, a novel antipsychotic with partial agonistic activity at dopamine D2 receptors, was introduced and the dose adjusted to 15mg a day. The patient showed significant improvement in apathy after six weeks of therapy with aripiprazole. DISCUSSION Depression is often mistaken for apathy, which is different in symptoms, presentation, and treatment options. Selective serotonin reuptake inhibitors are known to cause or increase symptoms of apathy in some patients. Recent evidence suggests that dopamine receptor agonists can be helpful in treatment of apathy. Apathy significantly improved in this patient after initiation of aripiprazole. CONCLUSION Aripiprazole may be useful for treatment of apathy syndrome. Its role in treatment of apathy requires further investigation in clinical trials.

Psycho-OncologyVolume 24, Issue 8 p. 971-972 Clinical Correspondence Clozapine and concomitant chemotherapy in a patient with schizophrenia and new onset esophageal cancer Varun Monga, Varun Monga Department of Psychiatry, Creighton University, Omaha, NE, USASearch for more papers by this authorMarin Broucek, Marin Broucek Department of Psychiatry, Creighton University, Omaha, NE, USASearch for more papers by this authorMojgan Amani, Mojgan Amani Department of Psychiatry, Creighton University, Omaha, NE, USASearch for more papers by this authorSriram Ramaswamy, Corresponding Author Sriram Ramaswamy Nebraska Western Iowa VA Healthcare System, Creighton University, Omaha, NE, USA Correspondence to: Nebraska Western Iowa VA Healthcare System, Creighton University, Omaha, NE, USA. E-mail: [email protected]Search for more papers by this author Varun Monga, Varun Monga Department of Psychiatry, Creighton University, Omaha, NE, USASearch for more papers by this authorMarin Broucek, Marin Broucek Department of Psychiatry, Creighton University, Omaha, NE, USASearch for more papers by this authorMojgan Amani, Mojgan Amani Department of Psychiatry, Creighton University, Omaha, NE, USASearch for more papers by this authorSriram Ramaswamy, Corresponding Author Sriram Ramaswamy Nebraska Western Iowa VA Healthcare System, Creighton University, Omaha, NE, USA Correspondence to: Nebraska Western Iowa VA Healthcare System, Creighton University, Omaha, NE, USA. E-mail: [email protected]Search for more papers by this author First published: 20 January 2015 https://doi.org/10.1002/pon.3744Citations: 8Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Daskalakis ZJ, George TP. Clozapine, GABAB, and the treatment resistant schizophrenia. Clin Pharmacol Therapeut 2009; 86(4): 442–446. doi:10.1038/clpt.2009.115 10.1038/clpt.2009.115 CASPubMedWeb of Science®Google Scholar 2Alvir JM, Lieberman JA, Safferman AZ, et al. Clozapine-induced agranulocytosis. Incidence and risk factors in the United States. New Engl J Med 1993; 329: 162–167. 10.1056/NEJM199307153290303 CASPubMedWeb of Science®Google Scholar 3Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003; 60: 82–91. 10.1001/archpsyc.60.1.82 CASPubMedWeb of Science®Google Scholar 4Seppälä N, Kovio C, Leinonen E. Effect of anticholinergics in preventing acute deterioration in patients undergoing abrupt clozapine withdrawal. CNS Drugs 2005; 19: 1049–1055. 10.2165/00023210-200519120-00006 CASPubMedWeb of Science®Google Scholar 5Bareggi C, Palazzi M, Locati LD, Cerrotta A, Licitral L. Clozapine and full-dose concomitant chemoradiation therapy in a schizophrenic patient with nasopharyngeal cancer. Tumori 2002; 88: 59–60. CASPubMedWeb of Science®Google Scholar 6Goulet K, Grignon S. Case report: clozapine given in the context of chemotherapy for lung cancer. Psycho-Oncology 2008; 17: 512–516. 10.1002/pon.1267 PubMedWeb of Science®Google Scholar 7Kolli V, Denton K, Borra D, Pulluri M, Sharma A. Treating chemotherapy induced agranulocytosis with granulocyte colony-stimulating factors in a patient on clozapine. Psycho-Oncology 2013; 22: 1674–1675. 10.1002/pon.3209 PubMedWeb of Science®Google Scholar 8Rosenstock J. Clozapine therapy during cancer treatment. Am J Psychiatr 2004; 161: 175–177. 10.1176/appi.ajp.161.1.175 PubMedWeb of Science®Google Scholar 9Walker AM, Lanza LL, Areallano F, Rothman KJ. Mortality in current and former users of clozapine. Epidemiology 1997; 8: 671–677. 10.1097/00001648-199711000-00014 CASPubMedWeb of Science®Google Scholar 10Keresztes RS, Port JL, Pasmantier MW, Korst RJ, Altorki NK. Preopertaive chemotherapy for esophageal cancer with paclitaxel and carboplatin: results of a phase II trial. Journal of Thoracic and Cardiovascular Surgery 2003; 126: 1603–1608. 10.1016/S0022-5223(03)00710-4 CASPubMedWeb of Science®Google Scholar Citing Literature Volume24, Issue8August 2015Pages 971-972 ReferencesRelatedInformation

Non-suicidal self-injury is a common occurrence in the population of individuals who suffer from schizophrenia, schizoaffective disorder, bipolar disorder, and other major psychiatric disorders.Many case reports have detailed self-inflicted injury to the eyes, genitals, or face in patients with major psychiatric disorders.We report an unusual occurrence of non-suicidal self-injury which consisted of the insertion of 7 copper wires into the chest cavity of an incarcerated 44 year old man suffering from schizoaffective disorder, which resulted in perforation of the cardiac muscle.The patient was diagnosed with schizoaffective disorder at age 18, and has attempted trials of several psychotropic medications.He was switched to clozapine approximately six months before the incident, and states that he declined his medications for several days before the self-mutilation.This patient denied suicidal ideation, and reports that his self-injury was a result of command hallucinations.We believe this to be a unique presentation of self-injurious behavior in a man with schizoaffective disorder.

pressure readings outside the normal range.A preoperative lipid panel revealed values which were all in the normal range, and an HDL that was 63, in the "optimal" range.Additionally, she had no personal or family history of heart disease, aortic dissection, aortic valvular disease, or connective tissue disease.

Objective: To report 6 cases of selective serotonin reuptake inhibitor (SSRI)– associated apathy syndrome. Case Summaries: In all 6 cases, the patient reported loss of motivation while being treated with an SSRI. Loss of motivation was of new onset and temporally associated with the use of the SSRI. A trial of discontinuation of the SSRI was performed in all 6 patients and 2 I were started on bupropion while cross-tapering from the SSRI. During the treatment trials, depression and apathy were monitored in all patients. Each case was assessed using the Apathy Evaluation Scale, Clinician version (AES-C), and by evaluating how the patient responded to discontinuation of the SSRI. Discussion: Scores on the AES-C improved significantly in all 6 cases after the SSRI was discontinued. Improvement was also seen in the motivation, novelty, and persistence subdomain scores of the AES-C. A pretreatment AES-C score was available only in the first case. Based on the Naranjo probability scale, there was a probable cause of apathy syndrome with SSRI therapy in the first case and a possible association in the rest of the cases. Conclusions: In some patients SSRIs may cause an apathy syndrome that can be reversed through discontinuation of the agent. When evaluating patients being treated with an SSRI, clinicians should have a high degree of suspicion and specifically inquire for this iatrogenic form of apathy syndrome.