Commentary On 2 Cases Of Takotsubo Cardiomyopathy Involving Psychotropic Medication

Takotsubo cardiomyopathy, also known as Takotsubo syndrome (TTS), is a cardiac syndrome first described in Japan in 1990 that typically follows an acute physical or psychiatric stressor, hence its association with the terms broken heart syndrome and stress cardiomyopathy. Although it is relatively rare, occurring in only 0.02% of the general population and roughly 2% of patients with acute coronary syndrome, neurological or psychiatric disorders are present in over 50% of affected individuals. One of the major hypotheses regarding the pathophysiology of TTS involves a catecholamine surge, from stress directly, or in some cases from psychiatric medication used to relieve distress. Given the association of TTS with acute stress and psychiatric illness, psychiatrists may be involved in the care of patients with TTS either at the initial presentation of the condition or following recovery. The case reports presented in this issue exemplify these 2 scenarios: one case involves the development of TTS during treatment with atomoxetine, and the other case involves treatment of depression in a patient after recovery from TTS, as well as a TTS recurrence during treatment with fluoxetine

A Brief Examination Of Integrated Care In Undergraduate Medical Education

Objective: This study examines how behavioral and physical health are currently integrated in undergraduate medical education, both in the classroom and during clinical rotations. Methods: Members of the Association of Directors of Medical Student Education in Psychiatry (n∈=∈215) were invited to complete a short survey on the integration of physical and behavioral health at their institution. Results: In addition to undergraduate medical courses traditionally taught by psychiatrists, behavioral science topics are often addressed in neurology, reproduction, and doctoring courses. During clinical rotations, behavioral health topics are most likely taught during the family medicine clerkship and, conversely, least likely during the surgery clerkship; furthermore, behavioral health topics are much less likely to be taught by psychiatrists during clinical rotations. Conclusions: Integration of behavioral and physical health in medical education is beginning to occur in a meaningful context

New Directions In Medical Education Related To Psychiatry

The 100-year anniversary of the Flexner report provides an opportunity to reflect on the future of medical education. We will consider the legacy of the original report, the centenary follow up to that report and consider how these, in concert with emerging learning theories, will influence medical education. We first provide a brief overview of the original Flexner report and review the recommendations of the 2010 centenary follow up to the report. We then discuss some of the major developments in learning theory and consider how they have influenced medical education. In general, there has been a gradual shift from passive to active methods, spurred in part by constructivist theories of learning. Many of the attitudes and skills required are particular strengths of the psychiatrist, making psychiatric educators particularly suitable to lead curricular change. Although much literature is devoted to determining the \u27best\u27 educational method, we take an ecumenical approach, suggesting that the various pedagogical approaches are all legitimate educational tools from which to choose. Each has its strength and limitations, and when designing a curriculum we should consider these when making pedagogical choices. We finish with some practical advice for those contemplating curricular change. © 2013 Institute of Psychiatry

Quantitative And Qualitative Analysis Of The Impact Of Adoption Of A Mobile Application For The Assessment Of Professionalism In Medical Trainees

Purpose Capturing either lapses or excellence in behaviors related to medical professionalism is difficult. The authors report a mixed-methods analysis of a novel mobile platform for assessing medical professionalism in a training environment. Method A mobile Web-based platform to facilitate professionalism assessment in a situated clinical setting (Professional Mobile Monitoring of Behaviors [PROMOBES]) was developed. A professionalism framework consisting of six domains (reliability, adaptability, peer relationships, upholding principles, team relationships, and scholarship) encompassing 25 subelements underpins the reporting structure. This pilot study involved 26 faculty supervising 93 medical trainees at two sites from January 12 to August 8, 2016. Notable professionalism behaviors were linked to the framework domains and elements; narrative details about incidences were captured on mobile devices. Surveys gauged the technological functionality and impact of PROMOBES on faculty assessment of professionalism. Qualitative focus groups were employed to elucidate user experience. Results Although users anticipated PROMOBES\u27s utility would be for reporting lapses in professionalism, 94.7% of reports were for commendation. Comfort assessing professionalism (P = .04) and recognition of the reporting procedures for professionalism-related concerns (P = .01) improved. PROMOBES attained high acceptance ratings. Focus group analysis revealed that the explicit connection to the professionalism framework was powerful; similarly, the near real-time reporting capability, multiple observer inputs, and positive feedback facilitation were strengths. Conclusions Making the professionalism framework visible and accessible via a mobile platform significantly strengthens faculty knowledge and behaviors regarding assessment. The strong desire to capture positive behaviors was an unexpected finding

Computer Simulation Games As An Adjunct For Treatment In Male Veterans With Alcohol Use Disorder

This study examined the impact of a computer simulation designed to provide the opportunity for individuals with alcohol use disorders (AUDs) to practice relapse prevention skills. Participants were 41 male veterans enrolled in an intensive outpatient substance abuse treatment program. Participants were randomly assigned to either view educational slides about treatment for AUD or play a simulation videogame for eight sessions within 12. weeks. Participants were assessed at a 4-week follow-up visit. Outcome measures included relapse rates as well as ratings on the Obsessive Compulsive Drinking Scale (OCDS) and a custom-designed relapse prevention self efficacy scale. While rates of relapse did not differ between groups, those who played the game showed overall reductions in ratings on the OCDS, as well as higher ratings of self-efficacy at week 8, suggesting that the videogame simulation may be a useful adjunct to AUD treatment. © 2013

Assessment Of Club Drug Use In A Treatment-Seeking Sample Of Individuals With Marijuana Dependence

Club drug use is becoming increasingly popular in the United States and has been associated with chronic psychiatric symptoms and neuropsychological abnormalities. Patterns of club drug use and characteristics of club drug users are not homogeneous. Thus, treatment-seeking marijuana-dependent individuals may have a differential pattern of club drug use. Baseline assessments collected from 55 individuals participating in a pharmacological treatment study for marijuana dependence were examined. Individuals completed a 16-item self-report questionnaire assessing club drugs used, frequency and patterns of use, problems associated with use, and reasons for use. Subjects were primarily male (87.3%) and Caucasian (81.8%), with a mean age of 32.1 (±9.1 years). As expected, a large number of individuals had used ecstasy (75%). However, LSD and methamphetamine use was also reported by many users (82.5% and 47.5% respectively), with many individuals reporting the use of more than one club drug. Notably, 31.6% of individuals reported tolerance to club drugs. These results emphasize the significant co-occurrence of club drug use in marijuana-dependent individuals. This appears to be the first study to report on club drug use in treatment-seeking marijuana-dependent individuals. Clinical implications and directions for future research are discussed. Copyright © American Academy of Addiction Psychiatry

Sex And Bipolar Subtype Association With Self-Reported Hazardous Alcohol Consumption In Bipolar Depression

Despite the high rate of co-morbid alcoholism in bipolar disorder, the relationship between mood state, sex, and alcohol consumption patterns has not been well studied. An anonymous Internet survey was conducted from August 2002 to September 2005. The survey asked participants with bipolar disorder to self-report alcohol quantity consumed when euthymic, manic, or depressed. Of 366 persons with bipolar disorder, significantly more males (38%) than females (23%) and bipolar II (31%) than bipolar I (16%) respondents self-reported consuming a hazardous amount of alcohol during depression. These preliminary findings suggest that hazardous drinking in bipolar depression is more common in men and in patients with bipolar II disorder. Further study is encouraged to assess whether this alcohol intake increase is a possible attempt at self-medication of mood symptoms or an independent co-morbid factor related to alcoholism. © 2008 by The Haworth Press. All rights reserved

An Open-Label Trial Of Aripiprazole Treatment In Dual Diagnosis Individuals: Safety And Efficacy

This open-label study evaluated the safety and efficacy of aripiprazole in the treatment of 20 patients with co-morbid schizophrenia, schizoaffective disorder, or bipolar disorder and alcohol, cocaine, and/or marijuana use disorders. Primary outcomes were substance use, measured by the Timeline Followback, and score on the Clinical Global Impression scale for psychiatric and substance use symptoms. The data suggest that aripiprazole may reduce substance use and improve psychiatric symptoms in patients with co-morbid disorders; however, limitations are noted. Subsequent randomized studies are needed to further explore these findings. Copyright © Taylor & Francis Group, LLC