Francisella as well as Antibodies

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.
Vaginismus is one of the most frequently occurring genito-pelvic pain disorders in women. Sexual dysfunction commonly presents with comorbid psychiatric disorders, and many patients suffering from the former exhibit the latter. The objective of this study was to investigate the affective temperaments of women with vaginismus compared to healthy controls.
Forty-eight women with vaginismus and 42 age-matched healthy women were recruited and compared in terms of their scores on the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire and a sociodemographic instrument.
Except for the scores for hyperthymic temperament, those for depressive, cyclothymic, irritable, and anxious temperaments were significantly higher in the vaginismus group than in the healthy controls (P<.05). The analysis of covariance indicated that the anxious temperament was significantly associated with covariants.
On the basis of the preliminary results, women with vaginismus may be candidates for bipolar disorder. This population should therefore be screened more carefully in terms of the development of the disorder. Bipolar disorder should also be considered when treatments for comorbid psychiatric disorders are needed.
On the basis of the preliminary results, women with vaginismus may be candidates for bipolar disorder. This population should therefore be screened more carefully in terms of the development of the disorder. Bipolar disorder should also be considered when treatments for comorbid psychiatric disorders are needed.Supportive therapy is a practical, flexible, and patient-centered psychosocial intervention that can help improve outcomes for patients struggling with a wide variety of medical illnesses. Due to its highly adaptable nature, brief supportive therapy can be practiced in busy clinical settings by consultation and liaison psychiatrists and primary care providers. In supportive therapy, the patient and provider work collaboratively to reduce distress and enhance functioning. The available evidence supports the use of supportive therapy techniques in managing the mental health consequences of medical conditions. This narrative review helps primary care providers learn and implement the basic goals and interventions of supportive therapy.
Attention-deficit/hyperactivity disorder (ADHD) in adulthood presents unique challenges for primary care providers, and many lack confidence addressing it. To support them, a workgroup of volunteer primary care and mental health providers created an Adult ADHD Toolkit containing information about the disorder and treatment advice. The objective of this study was to establish the impact of implementing the toolkit in primary care.
Providers completed a survey immediately before and 5 months after the toolkit was implemented. Participation was voluntary and anonymous. Also, prescriptions for stimulant and nonstimulant adult ADHD medications were tracked 6 months before and 6 months after the toolkit was introduced.
The response rate was 77.4% (n=24) at baseline and 64.5% (n=20) at follow-up. At follow-up compared to baseline, participants reported significantly higher comfort for assessment of adult ADHD (P=.039). Participants also reported higher comfort for nonmedication management (P=.10). There was no difference for comfort with medication management or prescribing practices pre versus post toolkit rollout, although participants were more comfortable with and prescribed a greater number of stimulants than nonstimulants.
Given the complexities of addressing adult ADHD, the results of this study are encouraging. Our findings highlight ways primary care providers can be supported, as well as areas that require greater attention. Still, more research is needed with a larger sample size to further explore and validate the efficacy of the toolkit.
Given the complexities of addressing adult ADHD, the results of this study are encouraging. Our findings highlight ways primary care providers can be supported, as well as areas that require greater attention. Still, more research is needed with a larger sample size to further explore and validate the efficacy of the toolkit.Posttraumatic stress disorder (PTSD) is an uncomfortable response that can follow exposure to 1 or more dangerous or frighteningly traumatic circumstances. Symptoms often include intrusive thoughts, insomnia, nightmares, flashbacks, avoidance behaviors, and hypervigilance or related emotionally troubling experiences. When overtly present, PTSD induces considerable emotional, social, occupational, and interpersonal dysfunctions. Psychotherapy is a commonly recommended initial intervention. There are a wide variety of techniques available. Psychotherapy can also be utilized as a preventative measure when intervention is available in the immediate aftermath of exposure to a potentially precipitating event. Most combat veterans with PTSD at Veterans Administration medical centers in the United States are prescribed pharmacotherapy. Different antidepressant, antipsychotic, adrenergic, and anticonvulsant medications are most commonly utilized. Optimal intervention for patients experiencing PTSD often includes prolonged follow-up that applies both talk and drug therapies in a supportive environment. This narrative review describes psychotherapeutic and pharmacologic approaches to treat PTSD.
Mounting evidence suggests that antipsychotics may have immunomodulatory effects, but their impact on disseminated infections remains unknown. This study thus sought to estimate the effect of antipsychotic treatment on the occurrence of bloodstream infection during long-term follow-up in adult patients with chronic obstructive pulmonary disease.
This retrospective cohort study, with new user and active comparator design, included adult patients seen from January 2008 to June 2018 in a tertiary teaching hospital in Buenos Aires, Argentina. New users of antipsychotic drugs were compared to new users of any benzodiazepine. The primary outcome of interest was incident bloodstream infection at 1 year of follow-up. Propensity score methods and a Cox proportional hazards model were used to adjust for baseline confounding.
A total of 923 patients were included in the present analysis. Mean (SD) age was 75.0 (9.8) years, and 51.9% of patients were female. The cumulative incidence of bloodstream infections at 1 year was 6.0% and 2.3% in the antipsychotic and benzodiazepine groups, respectively. Antipsychotic use was associated with a higher risk of bloodstream infections during the first year of follow-up (hazard ratio [HR] = 2.41; 95% CI, 1.13 to 5.14) compared to benzodiazepine use. Antipsychotics with high dopamine receptor affinity presented greater risk than less selective agents (HR = 5.20; 95% CI, 1.53 to 17.67).
Antipsychotic use is associated with bloodstream infections during the first year of follow-up in adult patients with chronic obstructive pulmonary disease. Further studies are warranted to confirm our findings and evaluate this effect in a broader population of patients.
Antipsychotic use is associated with bloodstream infections during the first year of follow-up in adult patients with chronic obstructive pulmonary disease. Further studies are warranted to confirm our findings and evaluate this effect in a broader population of patients.
The aim of this report was to evaluate the psychometric properties of the Pain Frequency, Intensity, and Burden Scale (P-FIBS), a brief measure of pain, as well as the association of pain with irritability and depression and how these symptoms relate to functional impairments.
Participants of 2 randomized controlled trials (Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care [EMBARC; n = 251 with DSM-IV diagnosis of major depressive disorder; study duration August 2011-December 2015] and STimulant Reduction Intervention Using Dosed Exercise [STRIDE; n = 302 with DSM-IV diagnosis of stimulant abuse or dependence; study-duration July 2010-February 2013]) and treatment-seeking patients in primary care clinics from an ongoing quality-improvement project (VitalSign
; n = 4,370; project duration August 2014-July 2019) were included. Psychometric properties of the P-FIBS were evaluated with confirmatory factor and item response theory analyses in EMBARC and VitalSign
. The appT01407094 (EMBARC), NCT01141608 (STRIDE).
To assess the safety and tolerability of folinic acid as an augmentation agent among geriatric inpatients with depression and to determine whether this augmentation was associated with decreased days of clinically needed hospitalization.
A retrospective chart review was conducted of the medical records of patients > 60 years of age discharged from a geriatric psychiatry unit between June 1, 2014, and February 1, 2016. Two groups were compared those with depression who received folinic acid (leucovorin) supplementation (n = 35) and those with depression who did not receive leucovorin (n = 80). The primary outcome measure was number of clinically needed days of hospitalization.
The mean ± SD number of days (logged) of clinically needed hospitalization in the leucovorin group was 2.0 ± 0.7 compared with 2.4 ± 0.6 in the nonintervention group. Unpaired t group analysis yielded the following t
 = 3.47, P < .0001 (2-tailed).
The patients who received leucovorin had a significantly reduced requirement of days of hospitalization, which translates to reduced cumulative cost of treatment during hospitalization. learn more Further studies, including randomized controlled trials, are recommended to explore this treatment option.
The patients who received leucovorin had a significantly reduced requirement of days of hospitalization, which translates to reduced cumulative cost of treatment during hospitalization. Further studies, including randomized controlled trials, are recommended to explore this treatment option.
Substance use disorder (SUD) is a chronic remitting and relapsing disorder, and abrupt discontinuation of the substance due to nonavailability in the absence of treatment precipitates withdrawals and craving. The objective of this study was to assess the craving and withdrawal coping mechanisms used by patients with SUDs as a result of disruption in availability of substances and medications due to sudden lockdown in response to coronavirus disease 2019.
A survey was administered via telephone from June 25, 2020, to July 15, 2020, to patients who had previously attended the substance use clinic of a tertiary care teaching hospital in North India from January 1, 2020, to March 21, 2020 (up to the time of lockdown). Sociodemographic and clinical details were obtained from case record files. A 16-item questionnaire was developed to collect information on coping with craving and withdrawal symptoms. A total of 215 patients were registered in the substance use clinic during this period for the treatment of SUDs, and of those, 43 could not be contacted due to various reasons such as wrong contact numbers, patient expired (not related to substance withdrawal), or not willing to talk.