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The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

A 20-year-old woman with no prior psychiatric and medical history presented with acute autobiographical memory loss and a psychogenic tremor. Her laboratory and imaging work-up revealed no infectious, inflammatory, or other organic etiologies. A lorazepam infusion-assisted interview successfully facilitated recovery of memories and elucidated precipitating events. We discuss the utility of drug-assisted interviews and the safety of benzodiazepine infusions for dissociative amnesia.

Background Valerian root is an herbal supplement used for its anxiolytic and sedative properties. Its extract is thought to serve as an allosteric modulator of gamma-aminobutyric acid A, which can cause delirium due to its influence on the nervous system’s inhibitory tone and its effect on the sleep-wake cycle. Objective This report presents a patient who developed delirium secondary to withdrawal from valerian root. Conclusion This report emphasizes the importance of screening for use and abstinence of herbal supplements when delirium develops, as herbal supplement withdrawal can be an uncommon and overlooked etiology of delirium.

Mental health clinicians often hear seriously ill patients ask the unanswerable: Why did this happen? What is the meaning of my suffering? In the inpatient setting, general medical ward, or oncology unit, patients are confronted with their mortality in new, urgent ways. Palliative medicine, or the specialized, comprehensive care of patients facing a life-limiting illness, occupies a unique and liminal space. Although often practiced by clinicians with non-mental health training backgrounds, there exists ample psychological content to be explored in the palliative care encounter. In this article, we present the case of a husband and international businessperson who experienced terminal complications from an advanced stage lung cancer. His illness was not responsive to multiple cancer-directed treatments, and he developed respiratory failure requiring high levels of supplemental oxygen support, from which he was unable to wean. Palliative care consultation was sought with the multiple objectives of ameliorating his severe death anxiety and persistent dyspnea as well as assisting in the clarification of his end-of-life wishes. Our goal with this case presentation and related discussion is to introduce the psychological aspects of palliative medicine to psychiatrists and psychotherapists.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Background Case reports continue to serve as valuable educational tools; they facilitate case-based learning and provide excellent opportunities for collaboration. Objective Our aim was to review the benefits of writing case reports and to analyze the characteristics of case reports published in a journal that focuses on care at the interface of psychiatry and medicine. Methods The literature on writing case reports as tools for medical education was reviewed. Then, case reports published in Psychosomatics were examined, and quantitative data (e.g., subjective quality measures, number of references and authors) were recorded. Results Of the 76 case reports published during a 3-year span (2015–2017), the majority examined an unusual presentation or treatment (86%), used an approach to teaching and critical thinking (84%), provided a sizable literature review (80%), and discussed a differential diagnosis of signs, symptoms, and disorders (53%). Conclusions Case reports provide intellectually-challenging opportunities for learning that foster scientific thought, encourage the use of evidence-based medicine, improve writing and critical thinking, provide experience with the peer-review process, and help to develop skills needed to write scholarly publications.

Heart disease is a chronic condition that affects millions of people worldwide. Research has led to improvements in treatment and increased longevity for patients. Heart disease is comorbid with many psychiatric illnesses that psychiatrists encounter in everyday practice. Thus, it is important for clinicians to have a basic understanding of heart disease, and its impact on their patients and their patients' treatments. In this article, we review the basic pathophysiology, epidemiology, and treatments for heart disease, and then describe a framework for managing the affective, behavioral, and cognitive considerations for patients with heart disease. We emphasize the identification of comorbid psychiatric illnesses and symptoms that directly or indirectly result from heart disease. Finally, we outline treatment strategies to improve overall cardiac health. [ Psychiatr Ann . 2019;49(2):55–59.]

The number of people who are overweight and obese has reached epidemic proportions in the United States. Estimates show that 78% of the adult population is either overweight, obese, or extremely obese. This represents a substantial increase from recent decades. Overwhelming scientific evidence links an increasing body mass index to increasing morbidity and mortality. Although numerous treatments for obesity are available, the cornerstone of treatment is behavioral modification, focusing on diet changes and exercise regimens. Additional therapies include a growing array of medications and surgeries. To improve care for patients who are overweight or obese, mental health providers should have a thorough understanding of overweight and obesity and its treatment to effectively address this topic with their patients. In addition, they must recognize that recidivism and failure to maintain weight loss is quite high, and that successful treatment requires a concerted and sustained effort. [ Psychiatr Ann . 2019;49(2):65–77.]

Many careers are available to psychiatrist-educators, and residents should learn about these pathways in addition to developing a core set of teaching skills regardless of their intended career trajectory. Clinician-Educator Programs offer structured opportunities for residents to explore advanced concepts, practice teaching skills, pursue scholarship, and receive mentorship in medical education. Women and persons from minority groups, particularly people of color and gender-diverse individuals, have long been passed over in the promotions process, and correction of these inequities is essential to creating a robust workforce of clinician-educators.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

BACKGROUND: Medicine relies on education of trainees for growth of the field. Medical education has benefitted from a rapid pace of innovation, but due to the coronavirus disease 2019 (COVID-19) pandemic, many paradigms underpinning the medical education of trainees shifted-rendering numerous teaching modalities unusable. The COVID-19 pandemic, however, accelerated the development of novel teaching methodologies, which our trainees are now adapting to. We sought to examine emerging teaching methodologies to understand the opportunities available for medical education to innovate our teaching practices for learners in the midst of the COVID-19 pandemic. METHODS: In this narrative review, we drew upon the experiences of the authors as both life-long learners and educators. We then reviewed literature pertaining to novel teaching methodologies developed in medical education since the start of the COVID-19 pandemic. RESULTS: Several medical specialties have employed novel teaching methodologies including use of telemedicine, remote teaching, online curricula, virtual rotations, virtual conferences, simulations, and learning consortia to continue engaging trainees during the COVID-19 pandemic. There is a paucity of literature that addresses efficacy of novel teaching methodologies compared to more traditional teaching methodologies. CONCLUSIONS: The COVID-19 pandemic presents an opportunity for medical education to combine new and innovative teaching methodologies to create novel, accessible, and engaging learning opportunities for our trainees.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Background Case presentation and analysis is a useful way to revisit key clinical themes, broad concepts, and teach others, especially when it comes to cross-cultural clinical issues. Patients from different cultural backgrounds tend to have different explanatory models of illnesses and related help seeking behaviors. Ineffective communication between clinicians and patients from nonmajority cultural groups may lead to less satisfaction with care and disparities in access to health care and in treatment outcomes. Conclusions To address health disparities, psychiatrists need to be able to understand the illness beliefs of all patients, particularly those from diverse cultural backgrounds. Using cultural humility to work with patients from all cultures by understanding the patients’ values and preferences is a key attitude for successful cross-cultural clinical encounters.

Approximately 637,000 lesbian, gay, bisexual, or transgender (LGBT)-identified documented adult immigrants live in the United States. LGBT people face persecution in dozens of countries around the world, where having an LGBT identity may be criminalized or even punishable by death. LGBT immigrants have often survived traumatic experiences in their countries of origin. In the United States, both LGBT non-immigrants and immigrants may experience significant stigma-related health disparities, which range from mental health problems to sexually-transmitted infections. LGBT immigrants in particular face challenges accessing culturally-competent health care, which has the potential to reduce health disparities. Trauma-informed approaches and an understanding of intersecting cultural identities can enable staff in health centers and clinics to support LGBT immigrants in overcoming health disparities, through implementation of best practices that meet the unique needs of these communities and improve engagement of LGBT immigrants in affirming and high-quality primary care and psychiatric care (i.e., collaborative care).

Background Delirium is an acute confusional state, associated with morbidity and mortality in diverse medically ill populations. Delirium is preventable and treatable when diagnosed but the diagnosis is often missed. This important and difficult diagnosis is an attractive candidate for computer-aided decision support if it can be reliably identified at scale. Objective Here, using an electronic health record–based case definition of delirium, we characterize incidence of this highly morbid condition in 2 large academic medical centers. Methods Using the electronic health record of 2 large New England academic medical centers, we calculated and compared the rate of the diagnosis of delirium using a range of administrative and discharge summary text-based case definitions over an 8-year period. Results Depending on case definitions, the overall delirium rate ranged from 2.0–5.4% of 809,512 admissions identified. The identified rate of delirium increased between 2005 and 2013, such that by the final year of the study, one of the two sites reported delirium in 7.0% of cases. The concordance between case definitions was low; only half of the cases identified by text analysis were captured by administrative data. Conclusion Delirium may be better captured by composite outcomes, including both administrative claims data and elements drawn from unstructured data sources. That the rate of delirium observed in this study is far lower than the current literature estimates suggests that further work on case definitions, identification, and documented diagnosis is required.

Background An increasing number of patients are admitted to general hospitals for injuries sustained in suicide attempts and for assessment of their ongoing risk for suicide. However, clinical staff may lack knowledge and expertise in the provision of a safe environment for potentially suicidal patients. Objective In an effort to follow the Joint Commission's recommendations on the care of suicidal patients, a Suicide Prevention Interdisciplinary Task Force was created. The task force sought to design and implement a suicide checklist that would facilitate creation of a safe environment for potentially suicidal inpatients on nonpsychiatric units in a general hospital. Methods We describe the development and implementation of a Care of the Suicide and Self-Injury Patient Checklist and report on data derived from incident reports related to self-harm/suicide attempts over a 4-year period. We also report results of a Research Electronic Data Capture survey of nurses' feedback on the checklist. Results After implementation of the Care of the Suicide and Self-Injury Patient Checklist, a total of 47 incidents of patient self-injury were reported over 4 years on nonpsychiatric inpatient units at a large general hospital; only three sustained permanent or serious harm. The Research Electronic Data Capture survey revealed that 88% of responding nurses believed that the Care of the Suicide and Self-Injury Patient Checklist guided creation of a safe environment and 90% believed that it supported consistent practice. Conclusions The Care of the Suicide and Self-Injury Patient Checklist contributed to the creation of a safe environment while caring for potentially suicidal patients on nonpsychiatric inpatient units and guided clinicians on the management of potentially self-injurious individuals.

Idiosyncratic adverse events related to psychotropic medications are prevalent and problematic, and they are the most frequent cause of postmarketing (or black-box) warnings and withdrawals of drugs from the market. This review examines the clinical nature of idiosyncratic adverse events, predictors of their onset, and the role of clinician awareness in avoiding irreversible and serious injury from medications prescribed for psychiatric conditions. Idiosyncratic reactions can be minimized or avoided by knowledge of risk factors, cautious use (or avoidance) of specific agents in subpopulations at risk, informed dose titration, and careful monitoring of clinical response. [ Psychiatr Ann . 2016;46(8):456–465.]

Received July 11, 2015; revised August 11, 2015; accepted August 12, 2015. From Harvard Medical School, 260 Longwood Avenue, Suite 168, Boston, MA 02115 (NE); Psychiatry Department, Massachusetts General Hospital, Boston, MA (DEM, TAS). Send correspondence and reprint requests to Neir Eshel, Ph.D., Massachusetts General Hospital, 260 Longwood Avenue, Suite 168, Boston, MA 02115; e-mail: Neir_Eshel@hms.harvard.edu & 2016TheAcademy of PsychosomaticMedicine. Published by Elsevier Inc. All rights reserved. Introduction