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ObjectiveMedical events such as myocardial infarction and cancer diagnosis can induce symptoms of posttraumatic stress disorder (PTSD). The optimal treatment of PTSD symptoms in this context is unknown.MethodsA literature search of 6 biomedical electronic databases was conducted from database inception to November 2018. Studies were eligible if they used a randomized design and evaluated the effect of treatments on medical event-induced PTSD symptoms in adults. A random effects model was used to pool data when two or more comparable studies were available.ResultsSix trials met full inclusion criteria. Studies ranged in size from 21 to 81 patients, and included patients with PTSD induced by cardiac events, cancer, HIV, multiple sclerosis, and stem cell transplantation. All trials assessed psychological interventions. Two trials comparing a form of exposure-based cognitive behavioral therapy (CBT) with assessment-only control found that CBT resulted in lower PTSD symptoms [Hedges's g = -0.47, (95% CI -0.82 - -0.12), p = .009]. A third trial compared imaginal exposure (another form of exposure-based CBT) with an attention control and found a trend toward reduced PTSD symptoms. Three trials compared eye movement desensitization and reprocessing (EMDR) with active psychological treatments (imaginal exposure, conventional CBT, and relaxation therapy), and found that EMDR was more effective.ConclusionCBT and EMDR may be promising approaches to reducing PTSD symptoms due to medical events. However, additional trials are needed in this patient population.

Assisted outpatient treatment (AOT) is a form of care that utilizes court orders to mandate treatment for individuals who suffer from severe mental illness and deteriorate due to nonadherence. AOT programs exist for select patients in many countries but in the United States are used extensively in only a minority of jurisdictions. While statutory frameworks are relatively similar, the resources available within AOT programs and the extent of utilization vary markedly by state. Evidence for efficacy comes primarily from mirror-image studies that follow patients before and after program enrollment, as well as certain sophisticated cohort studies performed in jurisdictions in which AOT is well resourced and where court orders are often in effect over extended periods of time. While mandated care inherently involves coercion, qualitative studies indicate that many patients enrolled in AOT programs identify some benefits of AOT when their symptoms improve. [Psychiatr Ann. 2024;54(5):e141–e145.] [ABSTRACT FROM AUTHOR]

Background: Exome sequencing is increasingly being used for clinical diagnostics, with an impetus to expand reporting of incidental findings across a wide range of disorders. Analysis of population cohorts can help reduce risk for genetic variant misclassification and resultant unnecessary referrals to subspecialists.Objective: To examine the burden of candidate pathogenic variants for kidney and genitourinary disorders emerging from exome sequencing.Design: Secondary analysis of genetic data.Setting: A tertiary care academic medical center.Patients: A convenience sample of exome sequence data from 7974 self-declared healthy adults.Measurements: Assessment of the prevalence of candidate pathogenic variants in 625 genes associated with Mendelian kidney and genitourinary disorders.Results: Of all participants, 23.3% carried a candidate pathogenic variant, most of which were attributable to previously reported variants that had implausibly high allele frequencies. In particular, 25 genes (discovered before the creation of the Exome Aggregation Consortium, a genetic database comprising data from a large control population) accounted for 67.7% of persons with candidate pathogenic variants. After stringent filtering based on allele frequency, 1.4% of persons still had a candidate pathogenic variant, an excessive rate given the prevalence of monogenic kidney and genitourinary disorders. Manual annotation of a subset of variants showed that the majority would be classified as nonbenign under current guidelines for clinical sequence interpretation and could prompt subspecialty referrals if returned.Limitation: Limited access to health record data prevented comprehensive assessment of the phenotypic concordance with genetic diagnoses.Conclusion: Widespread reporting of incidental genetic findings related to kidney and genitourinary disorders will require stringent curation of clinical variant databases and detailed case-level review to avoid genetic misdiagnosis and unnecessary referrals. These findings motivate similar analyses for genes relevant to other medical subspecialties.Primary Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases and National Human Genome Research Institute. [ABSTRACT FROM AUTHOR]