Background: Delirium and depression are often thought of as mutually exclusive conditions. Howeve... more Background: Delirium and depression are often thought of as mutually exclusive conditions. However, several studies cite depression as a risk factor for delirium whereas others note that patients with delirium often manifest depressive symptoms. Whether these depressive symptoms persist after delirium resolves remains unclear. Objectives: This article reviews published studies that have investigated the relationship between depression and delirium. Methods: Literature searches on PubMed, CINAHL, Cochrane Library, and Psy-cInfo were conducted using search criteria "delirium" AND "depressn" as keywords or MeSH terms. Results: Of 722 search results, 10 prospective cohort studies were identified for inclusion. These studies were categorized regarding the time of assessment for depressive symptoms. Included studies varied greatly (regarding their index population, their methods of assessment, and their timing of assessments). Of the studies, 3 involved patients undergoing hip fracture repair. They demonstrated more severe depressive symptoms both during delirium and after delirium ended. Conversely, the other studies did not find any statistically significant correlations between the 2 conditions. Conclusions: The literature suggests a correlation between depression and delirium in patients with hip fracture. Whether other specific populations have higher comorbidity is unclear. Unfortunately, studies varied widely in their methods, precluding a meta-analysis. Nonetheless, our review provides a foundation for future research.
Escitalopram is the newest selective serotonin reuptake inhibitor (SSRI) available for use in the... more Escitalopram is the newest selective serotonin reuptake inhibitor (SSRI) available for use in the United States. It has been approved for the treatment of major depression and generalized anxiety disorder. It is the S-enantiomer of the SSRI citalopram and is highly serotonin specific as it has minimal effect on the reuptake of dopamine or norepinephrine. It is also a well-tolerated medication, with a side-effect profile comparable to the other SSRIs. While a number of side effects have been seen during escitalopram therapy, such as insomnia, nausea, and increased sweating, there are no reported cases of serotonin syndrome associated with escitalopram therapy to date. We present the case of a 24-year-old woman who developed serotonin syndrome after an increase in her escitalopram to 30 mg/day. We will review the diagnostic criteria of serotonin syndrome and the clinical scenarios in which serotonin syndrome can develop. We will also discuss the proposed treatments and role that polypharmacology may play in the development of this clinical entity.
Zolpidem is one of the newer medications developed for the treatment of insomnia. It is an imidaz... more Zolpidem is one of the newer medications developed for the treatment of insomnia. It is an imidazopyridine agent that is an alternative to the typical sedativehypnotic agents. Zolpidem use is gaining favor because of its efficacy and its side effect profile, which is milder and less problematic than that of the benzodiazepines and barbiturates used to treat insomnia. Still, side effects are not uncommon with zolpidem use. We report a series of cases in which the patients developed delirium, nightmares and hallucinations during treatment with zolpidem. We will review its pharmacology, discuss previous reports of central nervous system side effects, examine the impact of drug interactions with concurrent use of antidepressants, examine gender differences in susceptibility to side effects, and explore the significance of protein binding in producing side effects.
A factitious disorder is typically a chronic illness that can be frustrating for the clinical tea... more A factitious disorder is typically a chronic illness that can be frustrating for the clinical team because it often eludes early diagnosis. Case reports in the literature show that patients can simulate almost any illness or disease state with some resorting to injecting themselves with contaminated substances to produce infection. A case is reported of a patient with self-induced bacteremia who presented with multiple episodes of polymicrobial bloodstream infections. The various types of factitious disorders and a review of treatment options are discussed. The current criteria for factitious disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 4th edition are reviewed.
Background: Repetitive transcranial magnetic stimulation (TMS) is a relatively new treatment moda... more Background: Repetitive transcranial magnetic stimulation (TMS) is a relatively new treatment modality for patients with major depressive disorder (MDD). Numerous studies have demonstrated the efficacy of TMS for MDD in the general population. However, there is limited information regarding clinical outcomes among veterans receiving TMS for MDD. Methods: The clinical outcome and characteristics of all veterans with MDD who were treated with TMS as outpatients at the James A. Haley Veterans' Hospital from October 2013 to December 2016 were assessed. Results: Among 40 patients who received TMS, there was a significant improvement of depressive symptoms using the Quick Inventory of Depressive Symptomatology-Self-Report (45% response, 20% remission) and the Montgomery-Åsberg Depression Rating Scale (61.9% response, 42.9% remission). In addition to significant improvement in depressive symptoms, self-report of anxiety symptoms and function significantly improved. TMS was generally well tolerated, with only a small percentage of patients discontinuing treatment due to side effects. No seizures or persistent adverse effects were observed or reported. Conclusions: TMS is an effective and well-tolerated option for MDD in a veteran population with significant treatment resistance and multiple comorbidities.
Mood disorders and psychosis in HIV Andrea Stolar, MD 1, Glenn Catalano, MD 2, Sheryl M. Hakala, ... more Mood disorders and psychosis in HIV Andrea Stolar, MD 1, Glenn Catalano, MD 2, Sheryl M. Hakala, MD 3, Robert P. Bright, MD 4 and Francisco Fernandez, MD 5 'Assistant Professor, Department of Psychiatry and Behavioral Medicine, University of South Florida, College of ...
Anticholinergic agents have multiple CNS effects, even when used in therapeutic doses. These can ... more Anticholinergic agents have multiple CNS effects, even when used in therapeutic doses. These can include sedation, amnesia, delirium and, in rare cases, psychosis. While there is some symptom overlap between delirium and psychosis, psychotic patients will have a clear sensorium. We present the case of a 59-year-old male who became psychotic and required hospitalization after the administration of a large anticholinergic load from a smoking cessation clinic. We will review the literature regarding previous cases of anticholinergic medication induced psychosis, discuss treatment options and review the clinical effects of anticholinergic medications.
Hypothyroidism is commonly associated with a variety of psychiatric conditions, most commonly dep... more Hypothyroidism is commonly associated with a variety of psychiatric conditions, most commonly depression and cognitive impairment, but up to 5% to 15% of symptomatically hypothyroid patients may develop a nonaffective psychosis, classically referred to as "myxedema madness." We report the case of a woman who developed Capgras syndrome in the context of hypothyroidism, and whose psychosis rapidly resolved with levothyroxine supplementation. To date, very few cases of Capgras syndrome related to hypothyroidism have been reported. The pathophysiology of this condition remains unclear but it may be related to global cerebral hypometabolism or possibly to increased cerebral dopamine. Given the robust response of "myxedema madness" to thyroid replacement, psychiatrists should remain vigilant for covert hypothyroidism in patients with psychosis and atypical histories or presentations.
The population of the United States is in great flux. In the 1970s and 1980s, as the baby boomer ... more The population of the United States is in great flux. In the 1970s and 1980s, as the baby boomer generation grew up, the majority of citizens were young, healthy, and often acted in the role of care provider to their loved ones. Today, as that generation ages, the populace is becoming more elderly, more medically unstable, and more likely to require care from family and social institutions. This cohort is now beginning to experience other difficulties associated with aging as well. The loss of a spouse or companion can be devastating, and this can be a major turning point in these patients’ lives. In fact, it is estimated that 51% of women and 14% of men will be widowed at least once after age 65. When bereavement is experienced in an appropriate manner, the patient can grieve their loss, fondly reminisce about shared experiences, and eventually move on through their developmental journey. They may spend time concentrating on their grandchildren, they may become involved in a cause they believe in, or they may mentor a young person with similar interests. However, when grief is complicated, it may become sufficiently severe as to induce any number of poor outcomes. These can include delayed or prolonged grief, suicidal ideations, new onset of psychotic symptoms, or the development of a major depressive episode. In this issue, Williams reviews the literature regarding the effects of bereavement and depression on recently widowed spouses. It is very obvious that bereavement often leads to depression and that both are associated with increased morbidity. In fact, patients with depression have been found to have an increased incidence of death from cardiovascular illness. It is not clearly understood how this happens, but there are multiple theories. These theories range from depression affecting health behaviors leading to the development of heart disease to depression promoting the development of atherosclerosis. Regardless of the association between cardiac illness and depression, the diagnosis and treatment of depression in the elderly will become of increasing importance as the population ages. Therefore, there must be an increase in the vigilance in which we screen for this disease. One of the first points to consider is whether the patient’s clinical presentation is a major depressive episode or simply bereavement. In those patients with a major depression, any mood symptoms are usually pervasive and unremitting. Mood fluctuations are common in patients who are experiencing grief, as they often describe grief as coming at them “in waves.” Other symptoms more common in major depression rather than grief include excessive guilt, suicidal ideations, preoccupations with worthlessness, unremitting functional impairment, and hallucinatory experiences (other than transiently seeing or hearing the deceased). This underlies the primary problem that there is often some difficulty in diagnosing depression in the geriatric population. In a recent study by Unutzer et al, it was noted that late life depression is common in the primary care setting but that it was not frequently diagnosed or treated. There are many reasons for this, including the fact that the elderly themselves minimize or deny their symptoms. They may become preoccupied with somatic symptoms, which may further decrease the chance of detection in the primary care setting. These may be cases of “masked” depression in which a patient focuses on physical rather than mood symptoms. Symptoms of depression may also overlap with dementia or may be assumed to be a part of “normal aging.” All of the above are reasons that all physicians will need to have a high index of suspicion for geriatric depression, especially in cases in which there is a greatly increased risk, such as a recent loss of a loved one. Unfortunately, the old mnemonic “SIG E CAPS” (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, and Suicide) is probably not a great choice to screen for geriatric depression, although it is better than no screen at all. However, there are a number of different scales that can be used. These include the Beck Depression Inventory, the Hamilton Depression Rating Scale, the Symptom Check List 90Revision, and the Zung Depression Scale, among others. However, these can take anywhere from 5 minutes to 20 minutes to administer and may not be viable choices in a busy primary care practice. In that case, consideration can be given to using the Beck Depression Inventory (which has a primary care and brief screen version) or the Geriatric Depression Scale, both of which are very brief and are patient self-report instruments. In summary, as physicians, we are looking at a significant increase in the number of geriatric patients seen in our practices in the very near future. As America ages, we need to be prepared so we can continue to provide the best medical care to our patients. That care includes being able to diagnose and treat depression in the…
The presence of psychiatric illness in general hospital medical inpatients can complicate a patie... more The presence of psychiatric illness in general hospital medical inpatients can complicate a patient's clinical course. Currently, there is no standard laboratory work-up recommended for this patient population. To begin to assess the utility of a routine panel of tests, the results of serum vitamin B 12 (cobalamin) levels, folate levels, thyroid stimulating hormone levels, and syphilis serology of 349 patients were reviewed. These patients had been admitted to the hospital for nonpsychiatric conditions but either had preexisting psychiatric disturbances or developed a mood spectrum disorder or cognitive spectrum disorder during their hospitalization. The incidence of vitamin B 12 and folate deficiencies in these patients was found to be higher than has been reported for the general population. Thus, routine screening for these vitamin deficiencies may be indicated because of their prevalence in this patient population.
Journal of Child and Adolescent Psychopharmacology, Dec 1, 2001
Risperidone is an atypical antipsychotic medication commonly used to treat psychotic illnesses in... more Risperidone is an atypical antipsychotic medication commonly used to treat psychotic illnesses in adults. It is being used with increasing frequency in children and adolescents, even though it has yet to be approved for use in this population by the Food and Drug Administration. There are few reports in the literature regarding its safety in those younger than 18 years of age. We present the case of a 15-year-old who ingested 110 mg of risperidone in a suicide attempt and developed only transient lethargy, hypotension, and tachycardia without any other significant effects. We review the literature regarding risperidone overdose in all age groups and review the current literature regarding pediatric overdose with the other atypical antipsychotics currently available in the United States. From those cases it seems that special care may be warranted with all pediatric cases of atypical antipsychotic overdose, including monitoring in a high-intensity clinical setting to manage potential respiratory or cardiac difficulties.
Strokes have been shown to result in psychiatric phenomena that can range from mood disorders to ... more Strokes have been shown to result in psychiatric phenomena that can range from mood disorders to psychosis. Ablative neurosurgeries have been performed with the goal of reducing the burden of psychiatric symptoms following such cerebrovascular accidents. In this report, we review poststroke psychiatric manifestations, and then present the case of a woman with schizophrenia whose thought disorder improved following a hemorrhagic stroke. Not only did she require less medication, but her remaining symptoms were significantly less impairing than they had previously been. We then compare and contrast the effects of this stroke with ablative neurosurgery.
While the number of medical students entering psychiatry has increased since the 1990's, little h... more While the number of medical students entering psychiatry has increased since the 1990's, little has been written about the program characteristics that draw students to specific psychiatry residency programs. We developed a survey regarding residency program characteristics and distributed it to the chief residents of each psychiatry residency program in the USA. Survey results were tabulated, and the presence of specific characteristics were correlated to the 2003 National Resident Matching Program (NRMP) results. We found that the presence of a substance abuse, geriatric psychiatry or a child and adolescent psychiatry fellowship were all associated with increased NRMP success. Programs with regular resident meetings had significantly higher success in the NRMP than those programs without meetings. Programs that had six or more PGY-I positions available in the NRMP revealed a trend towards higher NRMP success than smaller programs. Finally, in some cases, higher intern salaries were associated with higher NRMP success.
Background: Delirium and depression are often thought of as mutually exclusive conditions. Howeve... more Background: Delirium and depression are often thought of as mutually exclusive conditions. However, several studies cite depression as a risk factor for delirium whereas others note that patients with delirium often manifest depressive symptoms. Whether these depressive symptoms persist after delirium resolves remains unclear. Objectives: This article reviews published studies that have investigated the relationship between depression and delirium. Methods: Literature searches on PubMed, CINAHL, Cochrane Library, and Psy-cInfo were conducted using search criteria "delirium" AND "depressn" as keywords or MeSH terms. Results: Of 722 search results, 10 prospective cohort studies were identified for inclusion. These studies were categorized regarding the time of assessment for depressive symptoms. Included studies varied greatly (regarding their index population, their methods of assessment, and their timing of assessments). Of the studies, 3 involved patients undergoing hip fracture repair. They demonstrated more severe depressive symptoms both during delirium and after delirium ended. Conversely, the other studies did not find any statistically significant correlations between the 2 conditions. Conclusions: The literature suggests a correlation between depression and delirium in patients with hip fracture. Whether other specific populations have higher comorbidity is unclear. Unfortunately, studies varied widely in their methods, precluding a meta-analysis. Nonetheless, our review provides a foundation for future research.
Escitalopram is the newest selective serotonin reuptake inhibitor (SSRI) available for use in the... more Escitalopram is the newest selective serotonin reuptake inhibitor (SSRI) available for use in the United States. It has been approved for the treatment of major depression and generalized anxiety disorder. It is the S-enantiomer of the SSRI citalopram and is highly serotonin specific as it has minimal effect on the reuptake of dopamine or norepinephrine. It is also a well-tolerated medication, with a side-effect profile comparable to the other SSRIs. While a number of side effects have been seen during escitalopram therapy, such as insomnia, nausea, and increased sweating, there are no reported cases of serotonin syndrome associated with escitalopram therapy to date. We present the case of a 24-year-old woman who developed serotonin syndrome after an increase in her escitalopram to 30 mg/day. We will review the diagnostic criteria of serotonin syndrome and the clinical scenarios in which serotonin syndrome can develop. We will also discuss the proposed treatments and role that polypharmacology may play in the development of this clinical entity.
Zolpidem is one of the newer medications developed for the treatment of insomnia. It is an imidaz... more Zolpidem is one of the newer medications developed for the treatment of insomnia. It is an imidazopyridine agent that is an alternative to the typical sedativehypnotic agents. Zolpidem use is gaining favor because of its efficacy and its side effect profile, which is milder and less problematic than that of the benzodiazepines and barbiturates used to treat insomnia. Still, side effects are not uncommon with zolpidem use. We report a series of cases in which the patients developed delirium, nightmares and hallucinations during treatment with zolpidem. We will review its pharmacology, discuss previous reports of central nervous system side effects, examine the impact of drug interactions with concurrent use of antidepressants, examine gender differences in susceptibility to side effects, and explore the significance of protein binding in producing side effects.
A factitious disorder is typically a chronic illness that can be frustrating for the clinical tea... more A factitious disorder is typically a chronic illness that can be frustrating for the clinical team because it often eludes early diagnosis. Case reports in the literature show that patients can simulate almost any illness or disease state with some resorting to injecting themselves with contaminated substances to produce infection. A case is reported of a patient with self-induced bacteremia who presented with multiple episodes of polymicrobial bloodstream infections. The various types of factitious disorders and a review of treatment options are discussed. The current criteria for factitious disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 4th edition are reviewed.
Background: Repetitive transcranial magnetic stimulation (TMS) is a relatively new treatment moda... more Background: Repetitive transcranial magnetic stimulation (TMS) is a relatively new treatment modality for patients with major depressive disorder (MDD). Numerous studies have demonstrated the efficacy of TMS for MDD in the general population. However, there is limited information regarding clinical outcomes among veterans receiving TMS for MDD. Methods: The clinical outcome and characteristics of all veterans with MDD who were treated with TMS as outpatients at the James A. Haley Veterans' Hospital from October 2013 to December 2016 were assessed. Results: Among 40 patients who received TMS, there was a significant improvement of depressive symptoms using the Quick Inventory of Depressive Symptomatology-Self-Report (45% response, 20% remission) and the Montgomery-Åsberg Depression Rating Scale (61.9% response, 42.9% remission). In addition to significant improvement in depressive symptoms, self-report of anxiety symptoms and function significantly improved. TMS was generally well tolerated, with only a small percentage of patients discontinuing treatment due to side effects. No seizures or persistent adverse effects were observed or reported. Conclusions: TMS is an effective and well-tolerated option for MDD in a veteran population with significant treatment resistance and multiple comorbidities.
Mood disorders and psychosis in HIV Andrea Stolar, MD 1, Glenn Catalano, MD 2, Sheryl M. Hakala, ... more Mood disorders and psychosis in HIV Andrea Stolar, MD 1, Glenn Catalano, MD 2, Sheryl M. Hakala, MD 3, Robert P. Bright, MD 4 and Francisco Fernandez, MD 5 'Assistant Professor, Department of Psychiatry and Behavioral Medicine, University of South Florida, College of ...
Anticholinergic agents have multiple CNS effects, even when used in therapeutic doses. These can ... more Anticholinergic agents have multiple CNS effects, even when used in therapeutic doses. These can include sedation, amnesia, delirium and, in rare cases, psychosis. While there is some symptom overlap between delirium and psychosis, psychotic patients will have a clear sensorium. We present the case of a 59-year-old male who became psychotic and required hospitalization after the administration of a large anticholinergic load from a smoking cessation clinic. We will review the literature regarding previous cases of anticholinergic medication induced psychosis, discuss treatment options and review the clinical effects of anticholinergic medications.
Hypothyroidism is commonly associated with a variety of psychiatric conditions, most commonly dep... more Hypothyroidism is commonly associated with a variety of psychiatric conditions, most commonly depression and cognitive impairment, but up to 5% to 15% of symptomatically hypothyroid patients may develop a nonaffective psychosis, classically referred to as "myxedema madness." We report the case of a woman who developed Capgras syndrome in the context of hypothyroidism, and whose psychosis rapidly resolved with levothyroxine supplementation. To date, very few cases of Capgras syndrome related to hypothyroidism have been reported. The pathophysiology of this condition remains unclear but it may be related to global cerebral hypometabolism or possibly to increased cerebral dopamine. Given the robust response of "myxedema madness" to thyroid replacement, psychiatrists should remain vigilant for covert hypothyroidism in patients with psychosis and atypical histories or presentations.
The population of the United States is in great flux. In the 1970s and 1980s, as the baby boomer ... more The population of the United States is in great flux. In the 1970s and 1980s, as the baby boomer generation grew up, the majority of citizens were young, healthy, and often acted in the role of care provider to their loved ones. Today, as that generation ages, the populace is becoming more elderly, more medically unstable, and more likely to require care from family and social institutions. This cohort is now beginning to experience other difficulties associated with aging as well. The loss of a spouse or companion can be devastating, and this can be a major turning point in these patients’ lives. In fact, it is estimated that 51% of women and 14% of men will be widowed at least once after age 65. When bereavement is experienced in an appropriate manner, the patient can grieve their loss, fondly reminisce about shared experiences, and eventually move on through their developmental journey. They may spend time concentrating on their grandchildren, they may become involved in a cause they believe in, or they may mentor a young person with similar interests. However, when grief is complicated, it may become sufficiently severe as to induce any number of poor outcomes. These can include delayed or prolonged grief, suicidal ideations, new onset of psychotic symptoms, or the development of a major depressive episode. In this issue, Williams reviews the literature regarding the effects of bereavement and depression on recently widowed spouses. It is very obvious that bereavement often leads to depression and that both are associated with increased morbidity. In fact, patients with depression have been found to have an increased incidence of death from cardiovascular illness. It is not clearly understood how this happens, but there are multiple theories. These theories range from depression affecting health behaviors leading to the development of heart disease to depression promoting the development of atherosclerosis. Regardless of the association between cardiac illness and depression, the diagnosis and treatment of depression in the elderly will become of increasing importance as the population ages. Therefore, there must be an increase in the vigilance in which we screen for this disease. One of the first points to consider is whether the patient’s clinical presentation is a major depressive episode or simply bereavement. In those patients with a major depression, any mood symptoms are usually pervasive and unremitting. Mood fluctuations are common in patients who are experiencing grief, as they often describe grief as coming at them “in waves.” Other symptoms more common in major depression rather than grief include excessive guilt, suicidal ideations, preoccupations with worthlessness, unremitting functional impairment, and hallucinatory experiences (other than transiently seeing or hearing the deceased). This underlies the primary problem that there is often some difficulty in diagnosing depression in the geriatric population. In a recent study by Unutzer et al, it was noted that late life depression is common in the primary care setting but that it was not frequently diagnosed or treated. There are many reasons for this, including the fact that the elderly themselves minimize or deny their symptoms. They may become preoccupied with somatic symptoms, which may further decrease the chance of detection in the primary care setting. These may be cases of “masked” depression in which a patient focuses on physical rather than mood symptoms. Symptoms of depression may also overlap with dementia or may be assumed to be a part of “normal aging.” All of the above are reasons that all physicians will need to have a high index of suspicion for geriatric depression, especially in cases in which there is a greatly increased risk, such as a recent loss of a loved one. Unfortunately, the old mnemonic “SIG E CAPS” (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, and Suicide) is probably not a great choice to screen for geriatric depression, although it is better than no screen at all. However, there are a number of different scales that can be used. These include the Beck Depression Inventory, the Hamilton Depression Rating Scale, the Symptom Check List 90Revision, and the Zung Depression Scale, among others. However, these can take anywhere from 5 minutes to 20 minutes to administer and may not be viable choices in a busy primary care practice. In that case, consideration can be given to using the Beck Depression Inventory (which has a primary care and brief screen version) or the Geriatric Depression Scale, both of which are very brief and are patient self-report instruments. In summary, as physicians, we are looking at a significant increase in the number of geriatric patients seen in our practices in the very near future. As America ages, we need to be prepared so we can continue to provide the best medical care to our patients. That care includes being able to diagnose and treat depression in the…
The presence of psychiatric illness in general hospital medical inpatients can complicate a patie... more The presence of psychiatric illness in general hospital medical inpatients can complicate a patient's clinical course. Currently, there is no standard laboratory work-up recommended for this patient population. To begin to assess the utility of a routine panel of tests, the results of serum vitamin B 12 (cobalamin) levels, folate levels, thyroid stimulating hormone levels, and syphilis serology of 349 patients were reviewed. These patients had been admitted to the hospital for nonpsychiatric conditions but either had preexisting psychiatric disturbances or developed a mood spectrum disorder or cognitive spectrum disorder during their hospitalization. The incidence of vitamin B 12 and folate deficiencies in these patients was found to be higher than has been reported for the general population. Thus, routine screening for these vitamin deficiencies may be indicated because of their prevalence in this patient population.
Journal of Child and Adolescent Psychopharmacology, Dec 1, 2001
Risperidone is an atypical antipsychotic medication commonly used to treat psychotic illnesses in... more Risperidone is an atypical antipsychotic medication commonly used to treat psychotic illnesses in adults. It is being used with increasing frequency in children and adolescents, even though it has yet to be approved for use in this population by the Food and Drug Administration. There are few reports in the literature regarding its safety in those younger than 18 years of age. We present the case of a 15-year-old who ingested 110 mg of risperidone in a suicide attempt and developed only transient lethargy, hypotension, and tachycardia without any other significant effects. We review the literature regarding risperidone overdose in all age groups and review the current literature regarding pediatric overdose with the other atypical antipsychotics currently available in the United States. From those cases it seems that special care may be warranted with all pediatric cases of atypical antipsychotic overdose, including monitoring in a high-intensity clinical setting to manage potential respiratory or cardiac difficulties.
Strokes have been shown to result in psychiatric phenomena that can range from mood disorders to ... more Strokes have been shown to result in psychiatric phenomena that can range from mood disorders to psychosis. Ablative neurosurgeries have been performed with the goal of reducing the burden of psychiatric symptoms following such cerebrovascular accidents. In this report, we review poststroke psychiatric manifestations, and then present the case of a woman with schizophrenia whose thought disorder improved following a hemorrhagic stroke. Not only did she require less medication, but her remaining symptoms were significantly less impairing than they had previously been. We then compare and contrast the effects of this stroke with ablative neurosurgery.
While the number of medical students entering psychiatry has increased since the 1990's, little h... more While the number of medical students entering psychiatry has increased since the 1990's, little has been written about the program characteristics that draw students to specific psychiatry residency programs. We developed a survey regarding residency program characteristics and distributed it to the chief residents of each psychiatry residency program in the USA. Survey results were tabulated, and the presence of specific characteristics were correlated to the 2003 National Resident Matching Program (NRMP) results. We found that the presence of a substance abuse, geriatric psychiatry or a child and adolescent psychiatry fellowship were all associated with increased NRMP success. Programs with regular resident meetings had significantly higher success in the NRMP than those programs without meetings. Programs that had six or more PGY-I positions available in the NRMP revealed a trend towards higher NRMP success than smaller programs. Finally, in some cases, higher intern salaries were associated with higher NRMP success.
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Papers by Glenn Catalano