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Objectives: Opioid misuse is a serious public health concern, yet few people seek treatment for this condition. Hospitals may be one opportunity to identify those with opioid misuse and to teach them skills to help manage their opioid misuse upon discharge. We tested the relationship between opioid misuse status and motivation to change substance use among patients admitted with substance misuse to an inpatient psychiatric unit in a medically underserved area in Baton Rouge, Louisiana, who attended at least 1 group session of motivation enhancement therapy combined with cognitive behavioral therapy (MET-CBT) from January 29, 2020, through March 10, 2022. Methods: Of the 419 patients in our sample, 86 (20.5%) appeared to misuse opioids (62.5% male; mean age, 35.0 y; 57.7% non-Hispanic/Latin White). At the beginning of each session, patients completed 2 measures of motivation—importance and confidence to change substance use—from 0 (not at all) to 10 (most). At the end of each session, patients rated perceived session helpfulness from 1 (extremely hindering) to 9 (extremely helpful). Results: Opioid misuse was associated with greater importance (Cohen d = 0.12) and confidence (Cohen d = 0.13) to change substance use and with attending more MET-CBT sessions (Cohen d = 0.13). Patients with opioid misuse rated sessions as highly helpful (score of 8.3 of 9), and these ratings did not differ from patients who used other substances. Conclusions: Inpatient psychiatry hospitalizations may provide an opportunity to identify patients with opioid misuse and introduce these patients to MET-CBT to learn skills to manage opioid misuse upon discharge.

Suicidal thoughts and behaviors (STBs) are among the most common reasons for admission to psychiatric inpatient units and a large percentage of these patients also engage in substance misuse. Yet, no known studies have examined whether patients with STBs admitted to inpatient psychiatry units are motivated to change their substance misuse and, if so, whether they benefit from MET-CBT for substance misuse while on the inpatient unit. This study assesses the relationship between STB and motivation to improve substance misuse among 321 (61.1% male

The Suicide Status Form-IV (SSF-IV) is the measure used in the Collaborative Assessment and Management of Suicidality (CAMS). The SSF-IV Core Assessment measures various domains of suicide risk. Previous studies established a two-factor solution in small, homogeneous samples; no investigations have assessed measurement invariance. The current investigation sought to replicate previous factor analyses and used measurement invariance to identify differences in the Core Assessment by race and gender. Adults ( N = 731) were referred for a CAMS consultation after exhibiting risk for suicide. Confirmatory factor analyses indicated good fit for both one- and two-factor solutions while the two-factor solution is potentially redundant. Configural, metric, and scalar invariance held across race and gender. Ordinal logistic regression models indicated that neither race nor gender significantly moderated the relationship between the Core Assessment total score and clinical outcomes. Findings support a measurement invariant, one-factor solution for the SSF-IV Core Assessment.

Introduction Whether positive or negative, the hidden curriculum is a powerful force in residents' professional formation and one place where professionalism is learned. As opposed to the explicit didactic curriculum or the implicit bedside teaching that goes on during rounds, the hidden curriculum reflects the culture of the environment in which a resident works. This exercise familiarizes participants with a scenario demonstrating a negative hidden curriculum and allows them to develop a deeper understanding of the impact of the hidden curriculum on learners as well as patients. Methods This role-play is a 20-minute small-group activity designed to teach the meaning of the hidden curriculum in medical education. Volunteers from the learner group choose a part in the role-play and read from the script. While they stand under their character names in front of projected PowerPoint slides, thought bubbles appear over their heads, demonstrating what the characters are thinking. After the role-play, the group discusses the role-play scenario, its relevance, and its implications. At the completion of the exercise, learners are asked to complete a commitment-to-change card, putting in writing any change in behavior that they anticipate as a result of the experience. Results We used this play exercise in a national workshop as an icebreaker. It was well received and instantly allowed participants to understand what is meant by the hidden curriculum and why it can affect our learners. Three months later, we followed up with the workshop participants. Of those who responded to our query (about 30% of attendees), virtually all had reflected on the lessons of the workshop and made some level of change to their thinking and behavior. Discussion This exercise mimics clinical scenarios that learners can relate to. It also allows the instructor to teach about the hidden curriculum without preaching. The script provided is a psychiatric one but could be adjusted to accommodate other specialties as well.

The following is a case report of a patient with Sydenham's chorea who later developed schizophrenia. Autopsy examination of this patient revealed mineral deposits in the basal ganglia. The deposition of minerals, especially iron, within subcortical brain structures has been associated with dopaminergic abnormalities, schizophreniform symptoms, and abnormal movement disorders. The psychosis these patients experience is sometimes resistant to treatment with traditional neuroleptics. A CT or MRI scan may prove useful in screening those patients with Sydenham's chorea that develop psychotic symptoms.

We report the case of an adolescent girl who was 14 years old at initial presentation. A shy, immature and timid individual, she began to have recurring, progressive episodes characterised by insomnia, paranoia, distorted thinking and mood instability with a mix of depressive and manic-like symptoms. An extensive medical work up was unrevealing. Her family noted a pattern that coincided with her menstrual cycle. An endocrine consult was obtained, and the diagnosis of catamenial psychosis was performed. After treatment with leuprolide, resulting in a shutdown of the hypothalamic-pituitary-ovarian axis, the patient’s symptoms were resolved completely.

Polydipsia in psychiatric patients is a common phenomenon often accompanied by long-germ complications including congestive heart failure, renal failure, seizures, coma, and death (Blum and Friedland 1983; Blum et al 1983; Delva et al 1989). A subgroup of polydipsic patients develop water intoxication with hyponatremia. The etiology of this water intoxication in schizophrenic patients is unclear, as the polydipsic behavior with massive amounts of consumed water alone is an insufficient explanation, and antidiuretic hormone (ADH) abnormalities have not been clearly established and delineated. Estimates of the prevalence of polydipsia among psychiatric patients range from 5% to ! 7% (Blum et al 1983; Shah and Greenberg 1992). The fact that these patients have a poorer prognosis is consistent with the severity of complications they experience (Viewig et al 1989). Attempts te explain polydipsia in psychiatric patients include examining the role of psychosis, neuroleptics, and physiologic studies in reference to thirst or ADH dysregulation (Delva et al 1990; Glusac et al 1990, Goldman et al 1988; lllowsky and Kirch 1988). More recently, studies have drawn an analogy between polydipsia in humans and animal models of schedule-induced or incentiveconditioning behaviors (Luchins 1990) These behaviors are propitiated by hippcgampal lesions. Given the large body of evidence incriminating temporal lobe pathology in schizophrenia (for review see Hyde et al 1991), it seems of interest to note a patient with complex partial seizures whose ictal presentation includes

hormone (TSH) levels (p = 0.02). Depressed hypothyroid patients had higher TSH levels (p < 0.001) and lower cortisol responses relative to matched controls (p = 0.03) than their nondepressed counterparts. These findings support animal work suggesting that hypothyroidism reduces central 5-HT activity. They also suggest a threshold effect in that those with the highest TSH levels had the lowest 5-HT-mediated endocrine responses and were most likely to be diagnoses as depressed.