PsychBabel

I apologize for the lack of posts, but it appears I have been blocked from accessing WordPress at work. I should have access again soon. Thank you.

QotM (Question of the Moment):
A person with poor self-care, perseveration, echolalia, poor organization and planning skills, apathy, and abulia would have damage to this specific brain area.

Answer to previous QotM:
Selective abstraction.

Questions of the Moment are derived from notes created by S. Hinds, M.D.

QotM (Question of the Moment):
In cognitive therapy, what term describes the tendency to focus on a detail taken out of context and to conceptualize the experience on the basis of this element?

Answer to previous QotM:
Children

Questions of the Moment are derived from notes created by S. Hinds, M.D.

So we in psychiatry are taught the Folstein Mini-Mental Status Examination (MMSE) early in our training. At times, I have wondered, how and when did the Folsteins come up with the MMSE? How was it first introduced? Then I came upon these articles:

• “The Mini Exam with Maximal Staying Power” [I know......... that title...urgh.]
• “Mini-Mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician“

It appears that answers those questions. A more detailed look at the MMSE in the future.

Psychiatrists in training are always looking for book recommendations. Books on psychopharmacology are especially sought after. There are many handbooks and texts out there. However, I have found one text in particular that has been a valuable resource for practical, evidence-based information.

Principles and Practice of Psychopharmacotherapy, 4th Edition.
By Philip G. Janicak, John M. Davis, Sheldon H. Preskorn, Frank J. Ayd, Mani N. Pavuluri

Book Cover

The chapters are laid out in a reader-friendly manner, rather than being packed full with minutiae in a disorganized fashion. After reading this text, most people should have a fairly comprehensive understanding of how to approach the pharmacologic treatment of the major mental illnesses.

About this text, one of my mentors, S. Hinds, M.D., writes in his book recommendation list:
“Written by acknowledged giants in psychopharmacology, it is pretty comprehensive in that it spends time on the diagnosis and etiology of each disorder before launching into pharmacological treatment. It also is comprehensive about all the clinical trials used for each drug and the bottom line regarding results. I also like that they’ve expanded sections on special populations (e.g., pregnancy). So, it is the go-to source for what works and what doesn’t and the evidence for each. It is so-so regarding the mechanism of action of pharmacological agents, and, lastly, it wouldn’t kill them to just step up and give their anecdotal opinions about treatment and treatment-resistance.”

I highly recommend it.

QotM (Question of the Moment):
PTSD is most common in what age group?

Answer to previous QoTM:
Nausea and dizziness.

Questions of the Moment are derived from notes created by S. Hinds, M.D.

The use of lithium can be complicated, and there are many aspects that can be discussed. For now, I will focus on the fact that lithium is a salt. This is something that seems to be forgotten at times.

Since lithium is a salt (lithium chloride) closely related to sodium, the kidneys will treat them in a similar fashion. If a person is dehydrated, the kidneys will try to retain salt in order to increase total body fluid volume. Therefore, until that fluid volume is replenished, excess salt will be resorbed and an increase in the levels of sodium and lithium can occur.  Significant dehydration (such as can occur with vomiting and/or diarrhea) can potentially lead to lithium toxicity.  Unfortunately, lithium toxicity can lead to nausea and diarrhea, resulting in further dehydration.

Lithium can also compete with sodium for resorption by the renal tubules and potentially lower the level of sodium in a person’s body. Those taking lithium need to maintain a regular diet with adequate salt intake and hydration.

 Partial References:
HealthyPlace.com
Bipolar World

FDA News
AP News: FDA approves brain-zapping device to relieve OCD

On February 19th, the U.S. Food and Drug Administration “approved a humanitarian device exemption for the first implantable device that delivers intermittent electrical therapy deep within the brain to suppress the symptoms associated with severe obsessive-compulsive disorder (OCD).”

Essentially, it is a pacemaker-like device that is implanted under the skin with four electrodes leading into areas of the brain. Such treatment has been used for movement disorders and likely modulates neural circuits that are hyperactive. This would be the first device for OCD. It is made by Medtronic, Inc. and is called the Reclaim Deep Brain Stimulator.

This type of treatment will likely be reserved for a small group of treatment-resistant individuals. According to Dr. Daniel Schultz, Director of the Center for Devices and Radiological Health, “Deep brain stimulation using the Reclaim system may provide some relief to certain patients with severe obsessive compulsive disorder who have not responded to conventional therapy. However, Reclaim is not a cure for OCD. Individual results will vary and patients implanted with the device are likely to continue to have some mild to moderate impairment in functioning and continue to require medications.”

Hopefully, this will prove to be more effective than the Vagus Nerve Stimulator treatment for depression.

We live in fascinating times.

QotM (Question of the Moment):
What are the two most common side effects of Buspar?

Answer to previous QotM:
Alcohol withdrawal.

Questions of the Moment are derived from notes created by S. Hinds, M.D.

“Excess mortality, causes of death and prognostic factors in anorexia nervosa.” The British Journal of Psychiatry (2009) 194: 10-17.

According to a study published in The British Journal of Psychiatry, women in Sweden with a diagnosis of anorexia nervosa were 6.2 times more likely to have died during a 30-year period than those in the general Swedish population. 6009 women with anorexia were followed up retrospectively, utilizing national registers based upon the personal identification numbers of Swedish residents. Causes of mortality were varied, but suicide was one of the most frequent causes of death in this group.

A six times greater likelihood of death – that’s a significant risk. In addition, anorexia nervosa (the nervous inability to eat) is one of the psychiatric diagnoses with significant physical morbidity. Unfortunately, it is also difficult to treat and is often associated with a host of comorbid issues. Treatment usually requires a concerted effort amongst a patient’s health providers and personal network. It is a disorder that most in the field of psychiatry run across infrequently, making it even more difficult to manage. Therefore, I highly recommend consulting with people who have familiarity with anorexia when treating someone with this diagnosis. I, personally, always ask for assistance in such situations.