Dawnelle Schatte

Domains of Chronic Stress and Suicidal Behaviors among Inpatient Adolescents.

Little is known about the role of chronic stress in youth suicidal behaviors. This study examined the relations between specific domains of chronic stress and suicidal behaviors among 131 inpatient youth (M age = 15.02 years) who completed measures of stress, suicidal ideation, suicide attempt, and suicide intent. After controlling for demographics, diagnostic status, past history of attempt, and life event stress, the predictors of suicidal ideation were chronic stress in family relationships, close friendship, and physical health. Chronic close friendship stress also predicted suicide intent among attempters after controlling for covariates. No domain robustly predicted the presence of an attempt or moderated the relation between life event stress and suicidal behaviors. These findings highlight the role of certain domains of chronic stress in suicidal ideation and suicide intent.

Potential for oxytocin use in children and adolescents with mental illness

Oxytocin, long known for its role in childbirth and breastfeeding, has recently come under investigation for its psychoactive properties. We investigated its potential for use in adolescent psychiatric populations for anxiety, depression, attachment disorders, and conduct disorder.

Precipitating Events in Adolescent Suicidal Crises: Exploring Stress-Reactive and Nonreactive Risk Profiles.

Factors distinguishing adolescents who experienced a precipitating event in the week preceding a suicidal crisis from those who did not were examined. Among 130 suicidal inpatients (mean age = 15.01 years), those who experienced a precipitating event reported significantly lower depressive symptom scores, better perceived problem solving, less suicidal intent, and a lower rate of prior suicide attempts than those without a precipitating event. Levels of trait impulsivity, suicidal ideation, and current attempt status did not differentiate groups. Findings provide preliminary evidence consistent with at least two possible pathways to a suicidal crisis. Clinical implications and future directions are discussed.

The ADMSEP Milestones Project

ObjectiveCredentialing bodies mandate that a medical school’s curriculum be based upon recognized guidelines. Within the field of psychiatry, the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) has previously published recommended guidelines for the pre-clinical and clerkship curriculum. Ongoing changes within the Liaison Committee on Medical Education’s requirements for medical school curricula, and the publication of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, necessitated review of these guidelines.MethodsADMSEP convened a task force of psychiatric educators to develop a consensus report outlining new guidelines. The ADMSEP membership reviewed and approved this final document.ResultsThe guidelines outline six core learning objectives with corresponding competencies. Each of these competencies specifies accompanying milestones to be achieved through the course of medical school.ConclusionsADMSEP believes these guidelines will aid educators in crafting a school’s psychiatric curriculum. Clearly articulated milestones may foster the further development of validated educational and assessment tools by ADMSEP and other organizations.

Erythema Multiforme vs. Dress Syndrome Associated with the Combined Use of Lamotrigine and Cyclobenzaprine: A Case Report

Lamotrigine is FDA-approved as a maintenance treatment of bipolar disorder, but its common off-label uses include bipolar depression and antidepressant augmentation in patients with major depressive disorder. Among other adverse effects, cutaneous reactions, particularly erythema multiforme, are cited as concerns during treatment with this medication. In order to minimize the risk of cutaneous side effect, efforts have been made to identify factors associated with a higher rate of lamotrigine-induced rash. We report here a case of Drug Reaction with Eosinophilia and Systemic Symptoms apparently precipitated by the associated use of lamotrigine and cyclobenzaprine.

Creating a Common Curriculum for the DSM-5: Lessons in Collaboration

In 2013, the introduction of the Fifth Edition of the Diagnostic and Statistical Manual ofMental Disorders (DSM-5) created a challenge and an opportunity for psychiatric educators. The challenge consisted of the necessity of revising a standing curriculum for educating medical students and other learners. The opportunity consisted of the stimulus for innovation and collaboration. We decided to take advantage of the challenge of the introduction of the DSM-5 to collaboratively create a new curriculum that could eventually be shared with others. Since some of us were experienced Team-Based Learning practitioners, and others were not, the innovation also created an opportunity to disseminate knowledge about the pedagogy. There are multiple reasons for organizations to work together around a shared goal [1]. When groups collaborate, they can improve decisionmaking, utilize multiple perspectives to solve complex problems, create synergies to enhance creativity and skill development, and pool resources to quicken responsiveness to evolving conditions. The success of a collaborative effort depends on a variety of factors described in published reports, including the environment, membership, process and structure, communication, purpose, and resources. We believed that the environment for our collaboration was ideal because of our shared need to revise our curricula in response to the introduction of the DSM-5. All members of our collaborative knew each other professionally, and several had previous experience working together. While all of the institutions involved in the collaborative had individual resources sufficient to complete a new curriculum, none were capable of autonomously developing the ambitious and high quality product we envisioned. The membership (e.g., collaborative faculty) included experienced clerkship directors and/or educational researchers and thus was capable of meaningfully contributing to the group effort. All members agreed to the process and structure developed by the primary investigator. We established regular communications to facilitate completion of our project via email, conference calls, and face-to-face visits. A clearly defined and shared purpose was developed based on the ensuing publication of the DSM-5. By pooling resources, the collaboration was able to result in a complete curriculum in a relatively short period of time. Following is a description of how we developed the collaboration and some of the lessons learned though our experiences. * Ruth E. Levine rlevine@utmb.edu

Field Guide to Boot Camp Curriculum Development

There is increasing scrutiny of all stages of medical education to ensure that training is efficient, meaningful, and competencybased. Those efforts extend to the final year of training so that students will enter residency with all of the abilities necessary for the task on day one of internship. The Accreditation Council for Graduate Medical Education (ACGME) Competencies and Association of American Medical Colleges (AAMC) Core Entrustable ProfessionalActivities (EPAs) [1] can serve as guides to what those needed tasks are [7]. Outcomes of crash courses have been studied for surgery and neurosurgery [8]. However, there is no specific literature on designing “boot camp” or crash courses to prepare students specifically in psychiatry. In this article, we describe our boot camp curricula development using the six-step approach suggested by Kern et al. [3]. We collaborated on needs assessment but individually developed boot camp curriculums at our respective schools, each course taking into account the resources and needs of our individual programs but sharing materials and information. Here, we describe the process of our curriculum development: Problem Identification and Needs Assessment, Goals and Objectives, Educational Strategies, Implementation, Evaluation, and Feedback.