Use of Clozapine in Women of Childbearing Age: A Literature Review and Recommendations

Concerns about medications in women of childbearing age include impact on fertility, pregnancy, neonatal outcome, breastfeeding, and behavioral teratogenesis. The objectives were to examine possible risks of clozapine on these parameters. PsycINFO and MEDLINE searches were performed and Novartis was contacted regarding their clozapine pregnancy registry. Since prolactin levels are not elevated with clozapine as they are with typical antipsychotics, there is not interference with fertility. Adverse pregnancy outcomes included gestational diabetes, should dystocia, seizure, and mild floppy infant syndrome. Higher concentrations of clozapine were present in breast milk than in maternal blood. Despite a lack of case-control prospective data, available information raises some questions regarding the safety of clozapine in pregnancy. Suggestions for treatment are made. Reproductive counseling should be given to women starting on clozapine. Individual risk-benefit assessments must be performed. In pregnant women taking clozapine, the clinician should screen for gestational diabetes and advise against breastfeeding

Guns, Schools, and Mental Illness: Potential Concerns for Physicians and Mental Health Professionals

Abstract Since the recent shootings in Tucson, Arizona; Aurora, Colorado; and Newtown, Connecticut, there has been an ever-increasing state and national debate regarding gun control. All 3 shootings involved an alleged shooter who attended college, and in hindsight, evidence of a mental illness was potentially present in these individuals while in school. What appears to be different about the current round of debate is that both proegun control and antiegun control advocates are focusing on mentally ill individuals, early detection of mental illness during school years, and the interactions of such individuals with physicians and the mental health system as a way to solve gun violence. This raises multiple questions for our profession about the apparent increase in these types of events, dangerousness in mentally ill individuals, when to intervene (voluntary vs involuntary), and what role physicians should play in the debate and ongoing prevention. As is evident from the historic Tarasoff court case, physicians and mental health professionals often have new regulations/duties, changes in the physician-patient relationship, and increased liability resulting from high-profile events such as these. Given that in many ways the prediction of who will actually commit a violent act is difficult to determine with accuracy, physicians need to be cautious with how the current gun debate evolves not only for ourselves (eg, increased liability, becoming de facto agents of the state) but for our patients as well (eg, increased stigma, erosion of civil liberties, and changes in the physician-patient relationship). We provide examples of potential troublesome legislation and suggestions on what can be done to improve safety for our patients and for the public

Filicide in Austria and Finland - A register-based study on all filicide cases in Austria and Finland 1995-2005

<p>Abstract</p> <p>Background</p> <p>Filicide is the tragic crime of murdering one's own child. Previous research has found that the offending parents are commonly depressed and that suicide is often associated as an actual act or an intention. Yet, filicide is an underreported crime and previous studies have been strained with methodological problems. No comprehensive international studies on filicide have been presented in the literature until now.</p> <p>Methods</p> <p>This was a descriptive, comprehensive, register-based study of all filicides in Austria and Finland during 1995-2005. Filicide-suicide cases were also included.</p> <p>Results</p> <p>Most of the perpetrators were the biological mothers; in Austria 72%, in Finland 52%. Suicide followed filicide either as an attempt or a fulfilled act in 32% and 54% of the cases in Austria and Finland, respectively. Psychotic mood disorders were diagnosed for 10% of the living perpetrators in Austria, and 12% in Finland. Non-psychotic depression was diagnosed in 9% of surviving perpetrators in Austria, 35% in Finland.</p> <p>Conclusion</p> <p>The data from the two countries demonstrated that filicide is such a multifaceted and rare phenomenon that national data from individual countries seldom offer sufficient scope for its thorough study. Further analyses are needed to produce a complete picture of filicide.</p

Murder in the Family

Event Description Dr. Susan Hatters Friedman will discuss the various types of murder within the family, which can range from infanticide to elderly partner homicide. Common characteristics among perpetrators and motives will be discussed, along with legal implications and prevention methods. Speaker Biography Susan Hatters Friedman, MD serves as the inaugural Phillip J. Resnick Professor of Forensic Psychiatry at Case Western Reserve University, where she also has appointments in the departments of Pediatrics, Reproductive Biology (Obstetrics/ Gynecology), and Law. Dr. Friedman currently serves as President-elect of the American Academy of Psychiatry and the Law (AAPL), and has served as Chair of the Law and Psychiatry committee at the Group for Advancement of Psychiatry (GAP). Dr. Friedman served as Editor of the GAP book entitled Family Murder: Pathologies of Love and Hate, for which she and GAP were awarded the 2020 Manfred Guttmacher Award. Dr. Friedman is also the Deputy Editor of the Journal of the American Academy of Psychiatry and the Law

Teaching Psychopathology In A Galaxy Far, Far Away: The Light Side Of The Force

Star Wars films are among the top box office hits of all time. The films have been popular internationally for almost 40 years. As such, both trainees and attending psychiatrists are likely to be aware of them. This article highlights a vast array of psychopathology in Star Wars films which can be useful in teaching, even when the characters are considered the good guys . Included are as follows: histrionic, obsessive-compulsive, and dependent personality traits, perinatal psychiatric disorders, prodromal schizophrenia, pseudo-dementia, frontal lobe lesions, pathological gambling, and even malingering. As such, Star Wars has tremendous potential to teach psychiatric trainees about mental health issues

Psychopathology In A Galaxy Far, Far Away: The Use Of Star Wars\u27 Dark Side In Teaching

Star Wars is well known, timeless, universal, and incorporated into shared culture. Trainees have grown up with the movies, and based on their enduring popularity, attending psychiatrists are likely to have seen them too. This article highlights psychopathology from the Dark Side of Star Wars films which can be used in teaching. These include as follows: borderline and narcissistic personality traits, psychopathy, PTSD, partner violence risk, developmental stages, and of course Oedipal conflicts