Isheeta Zalpuri

Does psychosis increase the risk of suicide in patients with major depression? A systematic review.

OBJECTIVE Over the years studies have shown conflicting results about the risk of suicide in psychotic depression (MD-psych). To understand this association, we undertook a comprehensive review of the literature to ascertain whether individuals with MD-psych have higher rates of completed suicides, suicide attempts or suicidal ideation compared to those with non-psychotic depression (MD-nonpsych). METHODS We searched Pubmed, PsycINFO and Ovid in English language, from 1946-October 2015. Studies were included if suicidal ideation, attempts or completed suicides were assessed. RESULTS During the acute episode of depression, patients with MD-psych have higher rates of suicide, suicide attempts, and suicidal ideation than patients with MD-nonpsych, especially when the patient is hospitalized on an inpatient psychiatric unit. Studies done after the acute episode has resolved are less likely to show this difference, likely due to patients having received treatment. LIMITATIONS Diagnostic interviews were not conducted in all studies. Many studies did not report whether psychotic symptoms in MD-psych patients were mood-congruent or mood-incongruent; hence it is unclear whether the type of delusion increases suicide risk. Studies did not describe whether MD-psych patients experienced command hallucinations encouraging them to engage in suicidal behavior. Only 24 studies met inclusion criteria; several of them had small sample size and a quality score of zero, hence impacting validity. CONCLUSIONS This review indicates that the seemingly conflicting data in suicide risk between MD-psych and MD-nonpsych in previous studies appears to be related to whether one looks at differences during the acute episode or over the long-term.

Social Media and Networking Competencies for Psychiatric Education: Skills, Teaching Methods, and Implications

The Internet has revolutionized medicine and health education, including person-centered and interdisciplinary collaborative patient care [1]. Millennial learners (born between 1981 and 1996) are often considered “digital natives,” including medical students, residents, and early career faculty. They utilize technology to search for information for education or pleasure [2, 3].Medical students and residents often start medical school with a robust online and social media presence for personal use [4–6], but have not begun to develop and hone general clinical skills, much less professional skills about the Internet and technologies. Except for telepsychiatric competencies, medical education as a whole has not kept pace with the media explosion [7]. The current hazards to the technology explosion include patients accessing misinformation about diagnoses and treatments [5], breach of confidentiality, privacy, and professional boundaries. Novice and more advanced learners, alike, require competency-based education related to this topic. Mid and advanced career faculty, often referred to as “digital immigrants,” may be technologically ill-informed [4], and most have not yet applied andragogy (adult learning theories) to the topics of Internet use, social media, and professionalism. Therefore, we have a paradox and a crisis: faculty may trail trainees with regard to hands on experience and expertise with technology and they may require faculty development training to keep current with benefits and potential pitfalls of media [8]. The AmericanMedical Association Professional Guideline on Social Media [9] proposes questions and scenarios as a starting place for clinicians to learn, advice, explore, and mentor others on the opportunities and challenges that arise in new and changing online platforms. Compliance officers and other healthcare leaders do not recommend social media engagement as part of care. An alternative perspective about social media guidelines and best practices comes from the Council of Residency Directors Social Media Task Force, which suggests that a residency program develops a social media policy and a training plan in concert with institutional officials, particularly via the offices of the designated institutional officer (DIO), public affairs, legal or privacy officer, and the information technology (IT) department [10]. This paper advances a framework for social and digital media competency development as the link between clinical care and training. It has three levels of competencies and provides suggestions to implement and teach them, while addressing faculty development needs in this area. Example competencies are described with a vignette, skills involved, and instruction on the teaching methods that may be particularly useful.

Decisional Capacity in Pregnancy: A Complex Case of Pregnancy Termination

Perinatal psychiatric illness is common and can carry significant morbidity and mortality for mother, fetus, child, and family. Among women pregnant in the past year, up to 25.3% meet criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorder, 8% meet criteria for a new psychiatric disorder, and 0.4% meet criteria for a psychotic disorder. Maternal schizophrenia and acute psychosis during pregnancy have been associated with higher risks of adverse pregnancy and birth outcomes, unplanned and unwanted pregnancies, parenting difficulties, and loss of custodial or parental rights. Perinatal psychiatric illness may impair a womans judgment, self-care, decision-making, giving rise to sensitive and complex legal and ethical issues related to psychiatric, obstetric, and neonatal care. Although the literature on perinatal psychiatric illness is growing rapidly, there is a relative absence of information on the complex legal and ethical issues that may arise in the care of these patients, especially regarding the question of pregnancy termination.

Therapeutic Assignments: Piloting a Way for Medical Students on the Psychiatry Clerkship to Interact with Patients Beyond the Initial Interview

Studies have shown that medical students on psychiatry clerkship enjoy a direct and high level of patient contact [1, 2] and find patient contact rewarding, enabling them to better appreciate the therapeutic potential of psychiatric interventions [3]. Students agree that forming a relationship with a patient can have therapeutic effects by imparting hope, decreasing isolation, and providing individualized attention [2]. Students can make a significant difference through understanding the patients’ needs and showing them that they care [2]. Improved communication with patients results in enhanced clinical outcomes and patient satisfaction [4, 5]. In recent times, several factors, including managed care mandates, have contributed to shorter inpatient stays on psychiatric units. Based on the authors’ experience, this can attribute to less time for more in-depth interviews that can help form long-term connections with patients. With this in mind, the authors introduced “Therapeutic Assignments” as a pilot in the psychiatry clerkship curriculum at the University of Massachusetts Medical School (UMMS). The objectives were to augment students’ comfort around communicating with patients about sensitive topics such as loss and grief, self-injury, and how substance use impacts a patient’s life, as well as to help students better understand their patients’ perspectives. Therapeutic Assignments

Treatment of Psychiatric Symptoms Among Offspring of Parents With Bipolar Disorder

AbstractPurpose of review Bipolar disorder is highly familial and has a protracted and diagnostically confusing prodrome. This review critically evaluates recently published literature relevant to the treatment of psychiatric symptoms in high-risk offspring of parents with bipolar disorder. Recent findings Non-pharmacological treatment options including psychotherapy, resilience promotion through good sleep, diet, and exercise hygiene, and omega-3 fatty acid supplementation are important first-line interventions for high-risk offspring. There has been some success in treating this population with open-label trials with mood stabilizers and atypical antipsychotics; however, these results have not been replicated in randomized controlled trails. Summary Despite some progress in early identification of symptoms in offspring of parents with bipolar disorder, there is scarce evidence supporting the treatment of these high-risk youth to prevent psychiatric symptoms from progressing to threshold bipolar or other psychiatric disorders. There is a need for prospective and randomized trials and research that identifies reliable biomarkers to individualize treatments for these youth.

Relationship between serum uric acid level and cardiometabolic risks in nondiabetic patients with schizophrenia.

This study examined the relationship between serum levels of uric acid and insulin resistance and metabolic syndrome in nondiabetic patients with schizophrenia. Outpatients diagnosed with schizophrenia or schizoaffective disorder participated in a multicenter, cross-sectional study. Fasting blood samples were obtained to determine serum levels of metabolic measures. A total of 135 patients were recruited for the study. A significant positive relationship was found between serum levels of uric acid and the homeostasis model of assessing insulin resistance (log transformed, r=0.394, P<0.001), and a significant negative relationship was found between serum levels of uric acid and low-density lipoprotein particle size (log transformed, r=−0.306, P=0.001) after controlling for potential confounding variables. Hierarchical multiple regression suggested that serum uric acid level is a significant predictor of insulin resistance (P=0.001) and of low-density lipoprotein particle size (P<0.015). Further, logistic regression showed that serum uric acid levels strongly predicted the condition of metabolic syndrome (odds ratio 0.630, 95% confidence interval 0.463–0.856, P=0.003). This study suggested that uric acid may be a clinically useful biomarker to indicate cardiometabolic risks in nondiabetic patients with schizophrenia.