Neurocognitive rehabilitation of Down syndrome

Blog post by Jean-Adolphe Rondal, Ph.D., jeanarondal@skynet.be, Emeritus Professor of Psycholinguistics at the University of Liège, Belgium, Juan Perera, Ph.D., asnimo@telefonica.net, Director of the Center Principe de Asturias, University of the Balearic Islands, Mallorca, Spain,  and Donna SPIKER, Ph.D., donna.spiker@sri.com  Program Manager of the Early Childhood Program, SRI International, Menlo Park, California, USA.

Down syndrome is one of the most commonly occurring developmental disorders, with considerable bodies of research within many different disciplines. Despite calls for strong interdisciplinary and transdisciplinary approaches to both research and treatment of developmental disorders, including Down syndrome, bringing together knowledge across disciplines in a systematic and comprehensive way is still rare. 

The utility of non-psychiatric phenotype in diagnosing secondary psychosis, and of psychopathology in diagnosing primary psychosis

Blog post by Rudolf N. Cardinal, clinical research associate, Department of Psychiatry, University of Cambridge, and honorary specialist registrar, Cambridgeshire and Peterborough NHS Foundation Trust, and Edward T. Bullmore, professor of psychiatry, University of Cambridge.

Psychosis originally meant any kind of disordered mental state [1], and subsequently a severe mental disorder involving loss of contact with reality [2, 3]. Nowadays it may be defined (1) narrowly as the presence of delusions and/or hallucinations without insight, or (2) more broadly to include delusions and/or hallucinations with insight into their hallucinatory nature, or (3) more broadly still to include disordered thought or speech, or (4) yet more broadly to include severe behavioural abnormalities including behavioural disorganization, gross excitement and overactivity, or psychomotor retardation and catatonia [4, 5]. Different classificatory systems vary slightly in their definition [4, 5].

A Mental Healthcare Model for Mass Trauma Survivors

Blog post by Metin Basoglu, Professor of Psychiatry, & Ebru Salcioglu, Associate Professor of Psychology and Research Associate, Trauma Studies, Department of Psychological Medicine, Institute of Psychiatry, King’s College London & Istanbul Center for Behavior Research and Therapy (ICBRT / DABATEM), Turkey

Mass trauma events, such as wars, armed conflicts, acts of terror, political violence, torture, and natural disasters affect millions of people around the world. Currently there is no mental healthcare model that is capable of addressing the needs of masses of trauma-exposed people, particularly the dispossessed populations of developing countries that often bear the brunt of mass trauma events. Effective dealing with this problem requires interventions that are (1) theoretically sound, (2) proven to be effective, (3) brief, (4) easy to train therapists in their delivery, (5) practicable in different cultures, and (6) suitable for dissemination through media other than professional therapists, such as lay people, self-help tools, and mass media. Current treatments commonly used with trauma survivors do not meet more than two or three of these requirements. The last requirement is particularly important, as even the most effective treatment is of limited use if it cannot be widely disseminated to millions of people in need of help.

Delirium as a Cause of Violent Behavior

Blog Post by James J. Amos MD, University of Iowa, USA

Another reason why it would important to prevent delirium is the risk for violence patients can have for themselves and others. Patients who would not otherwise be violent can sometimes become violent when exposed to medications with which they’re unfamiliar. One combination of drugs that most people tolerate well but which can provoke intoxication delirium in others is Versed and Fantanyl. Versed is a sedative-hypnotic in the benzodiazepine class (Valium is in the same class) and Fentanyl is an opioid pain killer. Demerol is another opioid pain-killer that is a well-recognized cause of delirium.

These medications are often used on outpatient minor surgical procedures to produce sedation and analgesia. Occasionally, the relaxed and pain-free states they produce can cause an altered mental state that make people appear as though they’ve been on an all-night bender on alcohol.

Letter from a Pragmatic Idealist

Blog Post by James J. Amos MD, University of Iowa, USA

I read with interest an article from The Hospitalist, August 2008 discussing the Center for Medicare and Medicaid Services (CMS) requirement for hospitals to submit information on Medicare claims regarding whether a list of specific diagnoses were present on admission (POA)[1]. The topic of the article was whether or not delirium would eventually make the list of diagnoses that CMS will pay hospitals as though that complication did not occur, i.e., not pay for the additional costs associated with managing these complications. At the time this article was published, CMS was seeking public comments on the degree to which the conditions would be reasonably preventable through application of evidence-based guidelines. I have no idea whether delirium due to any general medical condition made the list or not. But I have a suggestion for a delirium subtype that probably should make the list, and that would be intoxication delirium associated with using beverage alcohol in an effort to treat presumed alcohol withdrawal.

Health care and mental illness

Blog Post by David Gardner, Professor of Psychiatry, Dalhousie University

Read also Cardiovascular Disease responsible for shorter life expectancy in people with mental illness

The health care received by people living with a major mental illness (outside of mental health care) is less frequent, of a lower standard, and leads to poorer outcomes when compared to the general population. This has been found in studies of people with a mental illness who also have hypertension, diabetes, HIV/AIDs, a major cardiovascular event, and so on. Two reports have offered striking examples of this.

Core Competencies and the Psychosomatic Medicine “Supraspecialty”

Blog Post by James J. Amos MD, University of Iowa, USA 

At the annual Academy of Psychosomatic Medicine (APM) meeting this year held on Marco Island, Florida, I heard Dr. Theodore Stern call Psychosomatic Medicine (PM) a “supraspecialty”. Usually it’s described as a subspecialty.  I couldn’t find the word in Webster’s although “supra” comes from the Latin for “above, beyond, earlier”. One of the definitions is “transcending”.  I tried to Google “supraspecialty” and came up empty. So I guess it’s a neologism. The context was a workshop on how to enhance resident and medical student education on Psychosomatic Medicine services. Dr.  Stern coined the term while talking about the scope of practice of PM. As he went through the long list, it gradually dawned on me why “supraspecialty” as a title probably fits our profession, mainly because it makes us, as psychiatrists, accountable for aspects of general and specialty medical and surgical care above and beyond that of Psychiatry alone.

Cardiovascular Disease responsible for shorter life expectancy in people with mental illness

Blog Post by David Gardner, Professor of Psychiatry, Dalhousie University

People living with a major mental illness have a quite notable shorter life expectancy, and the primary reason for this is surprising to some. The risk of death due to suicide is about 15-30 times greater in people with schizophrenia, bipolar disorder, and depression compared to the general population. However, suicide, a rare event, is not the leading driver of excess death or shortened life expectancy. It is cardiovascular disease.

Inpatient psychiatry

Blog Post by Michael Casher, MD, Director, Psychiatry Adult Inpatient Program, Clinical Assistant Professor, Department of Psychiatry, University of Michigan Medical School

Inpatient psychiatry may yet join consultation psychiatry (psychosomatic medicine) as a subspecialty within American psychiatry in the future.  There is a growing movement within many branches of medicine for “hospitalists”, physicians who spend the majority of their time taking care of hospitalized patients.  This is especially common now in the U.S. in the fields of internal medicine, pediatrics, and neurology, but there are now beginning to be a number of psychiatric hospitalists as well, including many in academic centers.  Inpatient psychiatry encompasses treatment of virtually all of the serious/severe mental disorders.  In our experience on a university-based psychiatric unit, we see quite a few patients with mood disorders and psychotic disorders, as well as borderline PD patients in crisis.  We also frequently take care of geropsychiatric patients with depression or dementia-related agitation.

Conversion Disorder

Blog Post by James J. Amos MD, University of Iowa, USA 

I was fascinated by the blog “The Mind in Modern Medicine” by E.S. Krishnamoorthy, et al, posted 10/21/2010. As a Psychosomatic Medicine (PM) specialist, I’m often consulted by neurologists for help managing hysteria, nowadays called conversion disorder. Although it’s been in the somatoform disorder category for many years, the opinion of many of my colleagues is that it’s more of a dissociative state.