Search

Background: Indiscriminate orders for urinalysis and urine cultures (UC) drive inappropriate antibiotic treatment (Abx), especially in older adults with mental health disorders. Lack of data regarding the prevalence of and treatment for infections in acute geriatric psychiatric units (GPU) motivated us to initiate this project. Aim: Our goal was to improve urine test utilization and reduce unnecessary Abx for asymptomatic bacteriuria (ASB) and contaminated UC. Methods: This retrospective review and prospective evaluation of bundled interventions was conducted in a 22- bed GPU in a community-based teaching hospital. Four hundred twenty-seven (427) patient records were reviewed for Abx and indication and 157 patients were assessed for the impact of bundled interventions. Results: Near 27% received Abx, primarily for a misdiagnosed urinary tract infection. Only 20% met clinical criteria; 80% were unnecessarily treated for ASB or contaminated cultures. Over two-thirds of the Abx consisted of fluoroquinolones or trimethoprim-sulfamethoxazole, neither of which are recommended due to adverse events and/or resistance. The impact of bundled interventions was marginally effective. Conclusion: Urinalysis and UC are indiscriminately ordered in older adults, resulting in inappropriate Abx with non-recommended agents. Urinalysis should not be a requirement for admission in asymptomatic patients given the high prevalence of ASB and pyuria in older adults. There is an opportunity for more collaboration within referring networks to standardize best practice.

Global studies show patient suicides among psychiatrists, including trainees, range from 33 to 80%. To our knowledge, there is no such data in the United States following a single study in 1988 regarding psychiatrists’ or resident trainees’ emotional response to patient suicide. The objective of our study was to assess the stress- and trauma-related symptoms following patient suicide in practicing psychiatrists and trainees. Data were collected by sending an online version of the survey to randomly selected psychiatrists and residency programs throughout the United States. Program directors were requested to share the questionnaires with their residents and fellows in training. Participants’ stress was assessed by the impact of event scale–revised version (IES-R). Our study shows 324 (63.6%) of the participants experienced patient suicide, which included 292 psychiatrists (76.1%) and 31 trainees (27.2%). Among the respondents, 3.8% of the psychiatrists and 9.7% of the trainees had clinically significant stress- and trauma-related disorders. The presence of higher levels of emotional exhaustion and depression than medical or surgical colleagues depicts the need for training programs, formal and informal support, workshops, or curricular changes to address this almost inevitable issue in a psychiatrist’s career.

Global studies show patient suicides among psychiatrists, including trainees, range from 33 to 80%. To our knowledge, there is no such data in the United States following a single study in 1988 regarding psychiatrists' or resident trainees' emotional response to patient suicide. The objective of our study was to assess the stress- and trauma-related symptoms following patient suicide in practicing psychiatrists and trainees.Data were collected by sending an online version of the survey to randomly selected psychiatrists and residency programs throughout the United States. Program directors were requested to share the questionnaires with their residents and fellows in training. Participants' stress was assessed by the impact of event scale-revised version (IES-R).Our study shows 324 (63.6%) of the participants experienced patient suicide, which included 292 psychiatrists (76.1%) and 31 trainees (27.2%). Among the respondents, 3.8% of the psychiatrists and 9.7% of the trainees had clinically significant stress- and trauma-related disorders.The presence of higher levels of emotional exhaustion and depression than medical or surgical colleagues depicts the need for training programs, formal and informal support, workshops, or curricular changes to address this almost inevitable issue in a psychiatrist's career.

Naltrexone is an opioid antagonist prescribed to treat opioid use disorder and as an anti-craving medication for alcohol use disorder. Gastrointestinal side effects are considered the most common, and liver damage is a serious and rare side effect of naltrexone. In this case report, we describe a 40-year-old patient who developed a seizure after initiating treatment with naltrexone. Although the mechanism is not clear as naltrexone is not a well-known pro-convulsant medication, a few hypotheses for association with seizure have been postulated based on the studies on opioid agonists and similar opioid antagonist naloxone. Based on this case report, we strongly recommend that clinicians should thoroughly assess the risk factors for seizures in patients before using naltrexone and start long-acting injectable naltrexone only after an adequate trial of oral naltrexone to minimize the risk of seizure.

The patient, a 56-year-old male veteran with a history of diabetes mellitus, hyperlipidemia, and generalized anxiety disorder, was admitted to an outside hospital for respiratory failure, cardiogenic shock, acute heart failure

Bupropion is generally considered safe and is widely used both as a monotherapy and as an augmentation agent for the treatment of major depression. Concerns have been raised about bupropion's propensity to precipitate new psychosis and worsen existing psychotic symptoms, although the mechanism is poorly understood. Three cases are reported in which bupropion use was associated with psychosis. The aim of the study was to explore the risk factors and possible mechanisms of psychosis in each case.Case 1 describes the interaction of cocaine abuse sensitization in a patient who developed psychosis with a lower dosage of bupropion. Cases 2 and 3 discuss the role of traumatic brain injury and structural brain lesions in increasing the risk of psychosis when using bupropion.Cocaine abuse, traumatic brain injury, and preexisting brain lesions appear to be risk factors for developing psychosis in persons taking bupropion. In such cases, clinicians should carefully assess the risks and benefits and closely monitor patients for symptoms of psychosis.

Background: In spite of having strong religious and cultural influences, substance abuse among adult population is very high in Punjab, a north Indian state of India in the border of Pakistan. A large majority of individuals with alcohol and substance dependence do not seek treatment. The primary objective of the study was to evaluate the barriers for which people in general population having alcohol and substance dependence do not seek treatment. There is paucity of data in India regarding barriers in treatment of substance abuse. Therefore, it was very tempting to evaluate these barriers. Method: Data was collected from the rural population of a randomly selected village by directly going to their home. Substance dependence was diagnosed by DSM-IVTR criteria in 412 persons and was assessed by Barriers to Treatment Inventory scale (BTI). Results: Among all the barriers ‘time conflict’ predominated in the study population by 51.2% followed by two other barriers ‘absence of problem’ (48.8%) and ‘fear to treatment’ (40.3%). Admission difficulty and poor treatment availability were relatively less prominent barriers. Female substance dependents had major problem with privacy (87.5%), fear to treatment (75%) and absence of problem (75%). Conclusion: This study shows that there are several barriers, certain beliefs, social influences and obligations in the population for which people can’t take treatment. Social stereotypes and fear to treatment due to poor health services add further vulnerability. Minimization of the barriers should be done by changes in education, screening, outreach, detection, and referral patterns in alcohol & substance abuse treatment delivery systems.

Late Onset Stress Symptomatology, Subclinical PTSD or Mixed Etiologies in Previously Symptom Free Aging Combat Veterans The reaction to combat stress is variable and complicated. When elderly combat veterans with no prior history of PTSD present to the Emergency Department (ED) with PTSD-like symptoms, the differential diagnosis can be perplexing. The case may be cofounded by multiple medical problems and early neurocognitive degeneration problems. A new diagnostic phenomena is lateonset stress symptomatology (LOSS) needs to be considered in late onset first time presentation of PTSD-like symptoms. It is a clinical phenomenon reported in aging combat veterans who have experienced stressful combat events in their early adult years followed by a successful post-military life.

Background: Psychiatric problems in children are rising and reported cases represent only the tip of the iceberg; large number remains unreported in India. There is limited data on childhood mental disorders and mental health needs in Northern-India. Aims and Objective: The main objective of this research was to study the extent and nature of psychiatric disorders in school children in a defined geographical area and to study their psychosocial correlates. Materials and Methods: In this cross sectional study, Childhood Psychopathology Measurement Schedule (CPMS) was used to measure the magnitude of 982 students in the age group of 10-15 years from four randomly selected schools in a city of North India. Screening stage was followed by detailed evaluation stage in which children were diagnosed by ICD-10 criteria. Statistical analysis was done by percentage and Chi-square test. Results: The results showed that among 982 students, 199 (20.2%) had psychiatric morbidity. Most of them were in the age group of 13-14 yrs, from middle income group and were second in birth order. No significant sexual preference was found regarding distribution of the disorders. Specific phobia; other non organic sleep disorders like sleep talking, bruxism; tension headache found to be the most prevalent disorders followed by sleep terror, hyperkinetic disorder, pica, enuresis. Conclusion: Epidemiological studies should be started early in childhood and carried longitudinally for development of preventive, promotional and curative programme in the community.