Puneet Narang

Do guns provide safety? At what cost?

Many people feel that having a gun provides greater safety for them and their family. Actually, having a firearm in the home escalates the risk for death or injury, while using it to shoot someone who endangers the household is much less common. The resultant injuries, deaths, emotional turmoil, and/or disabilities lead to greater utilization of health care and legal/police services. Payment for these expenses is provided by higher insurance premiums and tax rates. This financial aspect has become a part of our countrys current political concern over firearm ownership rights, gun violence or regulation, health care costs, the economy, and taxes.

Depression and Anxiety Following Early Pregnancy Loss: Recommendations for Primary Care Providers

Early pregnancy loss is a shocking and traumatic event for women and their families. Miscarriage usually induces an intense period of emotional distress. This reaction tends to improve over the following several months, but some residual psychological concerns remain. It is important to screen for depression and anxiety in patients following a miscarriage. Most women in this circumstance do become pregnant again, yet mood disturbances can still coexist. When women are having difficulties at conception, worries may be magnified. Most women and physicians see post-miscarriage intervention as desired, and it is important to provide appropriate treatment. Management of depressive and anxiety symptoms after pregnancy loss can benefit future patient well-being.

Ketamine as an electroconvulsive therapy anesthetic agent.

whereas the therapeutic effect persisted with M-ECT. They concluded that the combination of M-ECTwith antipsychotics is a safe and effective strategy for the consolidation of the therapeutic response in elderly and middle-aged experiencing catatonic schizophrenia and who relapse after stopping ECT despite continued antipsychotic treatment. Another study including 19 patients found that the M-ECT was effective on mood, anxiety, and delusional symptoms and on suicidal behavior. It allowed also reducing by 80% the average duration of hospitalizations per year. The interval between sessions was 1 to 5 weeks. Synergistic mechanisms of this association are not yet clear. A synergistic effect of this combination is possible through the potentiating of the effect of various neurotransmitters. It has also been hypothesized that ECTalter the permeability of the bloodbrain barrier andwould increase the crossing of clozapine which would potentiate the efficacy of this molecule without increasing systemic adverse effects.

Pharmacotherapy for Insomnia in Primary Care

Pharmacotherapy for insomnia in primary care settings can be challenging. Frequently, there are multiple coexisting medical and psychiatric conditions, drug interactions, concern regarding use of habit-forming sleep aids, and paucity of time in office visits to discuss management of sleep difficulties. This article reports the results of a literature search related to pharmacotherapy for insomnia and presents 4 clinical vignettes with corresponding treatment options.

Suicide Among Transgender and Gender-Nonconforming People

Suicide rates are higher in those who identify as transgender or gender nonconforming (TGNC) compared to the overall population. Suicide risk factors include discrimination, family rejection, internalized transphobia, and being denied appropriate bathroom or housing access. It is important to assess the risk of suicide among transgender and gender-nonconforming patients and discuss past experiences of prejudice or maltreatment to prevent further victimization. This narrative review includes the most pertinent literature from the past 17 years on issues related to suicide among individuals who identify as TGNC. ​.

Electroconvulsive Therapy During Pregnancy: (Brief Report)

Women often experience worsening mood disorder symptoms during pregnancy. Women with mood disorders have an increased risk for suboptimal prenatal care, inadequate weight gain, and more substance abuse during pregnancy. It is often difficult to balance pharmacotherapy risks to a developing fetus versus not medicinally treating maternal mental health conditions. Electroconvulsive therapy (ECT) is a rapid and effective treatment option that can be an appropriate intervention in some women during pregnancy. This report presents an overview of ECT in pregnancy and the case of a 28-year-old pregnant woman with bipolar mania who responded well to ECT.

The Biological Basis to Personality Disorders

Objective To provide understanding into the biological basis of thinking and behavior in people with personality disorders, explain anatomic findings, and appraise therapeutic options. Data Sources PubMed was searched with no date restrictions using the terms personality disorders DSM-5, cluster B personality disorders, biological psychiatry of personality disorders, neurobiology of personality disorders, and neurobiology of cluster B personality disorders. Study Selection/Data Extraction We identified 2,790 English-language articles and utilized 18 in this report. Results There are anatomic features typical to the brains of individuals with cluster B personality disorders, for example, abnormalities in the superior frontal cortex and amygdala and enlarged striatal volumes. Emotional dysregulation and impulsiveness are 2 prominent symptoms. Hereditary factors may contribute to the development of such conditions. Conclusion Understanding the neurobiology of cluster B personality disorders expands knowledge that hopefully results in better clinical management and development of improved treatments. Psychotherapy is currently the most effective intervention for borderline personality disorders. Symptomatic pharmacotherapies may be prescribed adjunctively on an individualized basis if clinically indicated (eg, with a coexistant depression).

Benefits of Dexmedetomidine in Management of Post-ECT Agitation

Abstract Electroconvulsive therapy (ECT) is an intervention for patients with a variety of psychiatric conditions. Occasionally, people exhibit dangerous degrees of agitation after this treatment, and some do not respond well to conventional pharmacotherapies. Dexmedetomidine is a central &agr;-2 agonist that can induce significantly calmative effects in persons with post-ECT agitation. The indication for it is in calming individuals with acute and/or recurrent posttreatment agitation. Dexmedetomidine is safe and effective when infused just before, or postictally, at ECT sessions.

Pharmacogenomics Can Enhance Prescribing of Psychiatric Medications

Abstract Many psychiatric patients experience pharmaceutical intolerances, and some of them do not derive optimal efficacy from their pharmacotherapies. Clinical problems such as these may result in prolonged dysfunction, adverse consequences, and repeated changes in medication treatment regimens. Pharmacogenomics is a laboratory method that aids individualized medication selection by predicting drug efficacy and adverse effect profiles. It is a technique that involves the testing of patients’ genetic makeup to improve medicinal response and tolerance. Pharmacogenomics aims to clarify pharmacokinetics and pharmacodynamics in addition to focusing on hepatic cytochrome enzyme metabolism. Ultimately, it facilitates optimal selection and adjustment of medications to enhance clinical outcomes. Pharmacogenomics is most useful in cases in which routinely prescribed pharmacotherapies are either suboptimally effective or have unacceptable adverse effects. Once there has been a failure of a therapeutic drug treatment, rather than “blindly” selecting an alternative medicine, pharmacogenomic test results can provide guidance for the selection of the most appropriate drug and its dose. The intent is to yield a greater likelihood of patient success in following a therapeutic intervention.

CHAPTER 15 – Psychiatric and Mental Health Aspects of Neurotoxic Exposures

The central nervous system effects of neurotoxic agents present a range of disturbances.1 The most striking aspects may include changes in mood and personality. For example, exposure to neurotoxins like manganese or carbon disulfi de can produce psychoses and suicidal tendencies. Exposure to solvents such as methylene chloride may result in delusions and hallucinations. Cognitive dysfunction manifests as lack of alertness, disorientation, reduced attention span, poor judgment, and memory loss, in addition to personality changes, after exposure to many neurotoxins, like carbon monoxide. An undefi ned fraction of neurological and psychiatric illness could be caused or exacerbated by chronic, lowlevel contact with environmental neurointoxicants. Most reported incidences focus on high-dose exposures that are usually encountered during accidents or in occupational settings. The impact of low-dose, long-term exposure to neurotoxic agents is a less studied area; therefore, results from sporadic reports are often unclear. Neurotoxic sequelae range from devastating illnesses, such as parkinsonism and dementia, to subtle changes, like alterations in behavior or limitations in memory and cognition.