Decision-Making Capacity in a Transgender Patient With Schizophrenia and Concerns for a Life-Threatening Skin Infection.

Assessing patient decision-making capacity while adhering to the requests of patients with mental illness remains a great ethical challenge. In patients with severe mental illness, the assessment of decision-making capacity can be difficult, particularly when a care team is also trying to navigate cultural, educational, and linguistic barriers. It becomes especially complex in situations where the patient is not only diagnosed with a severe mental illness but also suffers from a comorbid medical illness that the patient refuses to have treated appropriately. Balancing patient wishes while respecting patient autonomy creates further issues when assessing decision-making capacity. As such, the following case presents a transgender man who suffers from schizophrenia with a persistent skin infection on the patient's torso secondary to wearing a brassiere for an extended period. This case report addresses the intricacies surrounding patient decision-making capacity, specifically in the psychiatric population.

Returning to college after inpatient psychiatric treatment: a case study of bipolar I disorder management.

Bipolar disorder is typically diagnosed in the teenage to early adulthood years. During this age, many individuals are students pursuing a college degree. Students developing the symptoms of bipolar disorder have a harder time navigating college and have significant difficulties transitioning back to school after psychiatric hospitalization, potentially influencing quality of life. Despite this, little attention has been given to the academic needs of hospitalized college students. This paper discusses the case of a 21-year-old female with a history of bipolar I disorder who was hospitalized for treatment of a manic episode. We discuss interventions to accommodate her educational needs during hospitalization to help minimize her academic load and ease her transition back to college. With this case study, we address the lack of well-established systems to reacclimate hospitalized college students and propose solutions to mitigate the hardships of transitioning from hospitalization back to the rigors of being a student.

A Holistic Approach to Cardiopulmonary Concerns in a Schizophrenic Patient and Ensuring Quality Care.

"Holistic approach" and "Quality Care" have been trending topics in the medical community for several decades, with holistic practice advocating for meeting patients' emotional, physiologic, psychological, and spiritual needs. In comparison, the quality care model highlights patient care metrics of equity, safety, and timeliness in medical treatment. Both converge on the concept of medical care centered around patients, with countless papers discussing their benefits in various healthcare settings. However, there is a gap in the literature regarding using both models to manage the mentally ill. Adopting the healthcare quality approach and incorporating a holistic perspective in managing psychiatric conditions can improve patient satisfaction and reduce societal and healthcare costs, making it an important area of further investigation. This paper will discuss the case of a 59-year-old male with schizophrenia who developed cardiopulmonary symptoms during his prolonged hospital stay, leading to extensive yet inefficient workup, in which his symptoms improved after implementing measures that uplifted his psyche. It will carefully examine holistic care's emotional and psychological aspects and the quality care domains for mentally ill patients. The case report aims to endorse integrating both models into the management of the psychiatric population to promote patient-centered and optimal quality of care.

A Case Study Demonstrating Applications of ChatGPT in the Clinical Management of Treatment-Resistant Schizophrenia.

Chat Generative Pre-trained Transformer, also known as ChatGPT, is a new artificial intelligence (AI) program that responds to user inquiry with discourse resembling human language. The range of ChatGPT capabilities caught the interest of the medical world after it demonstrated its ability to pass medical boards examinations. In this case report, we present the clinical treatment of a 22-year-old male diagnosed with treatment-resistant schizophrenia (TRS) and compare the medical management suggested by ChatGPT to current standards of care in order to assess the program's ability to identify the disorder, evaluate potential medical and psychiatric work-up, and develop a treatment plan addressing the distinct nuances of our patient. In our inquiry with ChatGPT, we found that it can accurately identify our patient as having TRS and order appropriate tests to methodically rule out alternative causes of acute psychosis. Furthermore, the AI program suggests pharmacologic treatment options including clozapine with adjuvant medications, and nonpharmacologic treatment options including electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and psychotherapy which align with current standards of care. Lastly, ChatGPT provides a comprehensive list of side effects associated with antipsychotics and mood stabilizers used to treat TRS. We found both potential for and limitations in the clinical application of ChatGPT to assist in the assessment and management of complex medical conditions. Overall, ChatGPT may serve as a powerful tool to organize medical data in a meaningful and palatable format for medical professionals to reference during patient care.

A Rare and Complex Case of Non-suicidal Self-Mutilation in a Patient With Schizophrenia.

The literature describing acts of non-suicidal self-mutilation (NSSM) in the adult population is limited. Of the cases that document NSSM, a disproportionate number of these individuals have a history of psychiatric illnesses. Although the motivation to perform NSSM varies across patients, the literature suggests that past self-injurious behaviors, extreme religious delusions, and command hallucinations are the most significant risk factors. The primary forms of NSSM include ocular, genital, and limb mutilation. Limb mutilation is the least common of the three and typically occurs proximal to the wrist or hand. Here, we present a rare case involving a 42-year-old man with schizophrenia who was hospitalized due to osteomyelitis of his autoamputated digits. This case is unique in involving multiple digits of the hand and using a rare amputation method. We aim to compare this case with the existing body of work on NSSM and identify factors that may predispose patients to act on these extreme impulses. We also highlight a novel interventional program that reduces psychiatric and medical comorbidities.

The Importance of Patient-Centered Care in Colon Cancer Patients With Severe Mental Illness.

There is an abundance of literature that highlights the importance of patient-centered communication with cancer patients requiring surgical intervention. While the need for communication for patients requiring surgery is well understood, less attention is brought to patients with severe mental illnesses. More literature is needed to highlight the importance and application of patient-centered care for patients suffering from both severe mental illness and cancer requiring surgical intervention. It is unclear if poor communication between patients and cancer-care specialists is part of the reason for the underlying discrepancy. Efforts to reduce this discrepancy may be worth considering as a priority for health care systems. We present a case of a 63-year-old man with schizophrenia who received a late cancer diagnosis after a missed screening, resulting in an extensive surgical resection for colon cancer. We explore the possibility of careful communication between the treating physician, patient, and patient's caretakers potentially preventing the delay in his cancer diagnosis. Effective communication is especially important with mental health patients because of its effect on long-term physical and mental outcomes. We hope to further the discussion on how to better cater to this specific population of patients undergoing cancer surgery.

The Coexistence of Oculocutaneous Albinism with Schizophrenia.

Oculocutaneous albinism (OCA) is an extremely rare skin disorder which occurs in 0.005% of the world population, whereas schizophrenia is a rare mental illness which affects 1% of the world population. Researchers have spent much time searching for the causes of schizophrenia, as they are still largely unknown. It was previously hypothesized that schizophrenia could be caused by a defect in melatonin metabolism, leading to increased melanin production and the production of hallucinogenic agent. However, this implies that albinos would be protected against schizophrenia (since they have little to no melanin production), and although rare, there have been several case reports of albinos with schizophrenia, refuting this hypothesis. Following their discovery of schizophrenic albinos, several researchers have instead wondered whether schizophrenia and albinism could actually be genetically linked. To further this discussion, we present a case report of a 25-year-old African-American male with OCA2 and schizophrenia. He was hospitalized after his mother discovered the existence of a BB that was lodged in his forehead from a failed suicide attempt in response to command auditory hallucinations. The BB was removed during his hospitalization, and he was psychiatrically stabilized on a combination of risperidone, lithium, and escitalopram.

A Case of Neuroleptic Malignant Syndrome in Pregnancy.

Neuroleptic malignant syndrome (NMS) is an obstetric emergency. Management of acute psychosis in a pregnant patient remains complicated with limited therapeutic options due to teratogenic effects. We report a case in which a patient's antipsychotic regimen during a viable pregnancy subsequently led to NMS, and discuss our chosen management for treating NMS.

Losing Legs to Losing Everything: How Neglecting Holistic Health Devastated a Lower-limb Amputee.

Holistic care means addressing the patient as a person; providing high-quality care by focusing on individual needs. Our goal is to implement a survey that quantifies the patients' physical, mental, and spiritual health to enable improvements in client-centered therapy in lower-limb amputees. For this, we worked with a 43-year-old Hispanic male with a medical history of insulin-dependent diabetes complicated by sequential lower limb amputations. The second amputation cost him his job and left him homeless. The patient was hospitalized after developing severe depression, to the point that he had command auditory hallucinations to kill himself. He was discharged back into the community after a three-week hospitalization. However, he was readmitted to the hospital a week later due to a resurgence of suicidal ideation. Our team engaged the patient using the "Holistic Health and Wellness Survey" of Raymond W. Smith, which we used to assess and address various domains of his mental, spiritual, and physical health. We were able to create obtainable goals for the patient for each category on which he scored low in the health and wellness survey. The patient's overall health and attitude improved substantially through his client-centered therapy, which addressed his quantified health needs; and he began to take an active role in developing short- and long-term goals that he found attainable as he adjusted to life as a double-amputee. This case illustrates the potential for improving client-centered therapy in lower-limb amputees. We believe that providers may benefit from implementing this health and wellness survey to better assess how to provide client-centered care for their patients.

Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial.

BACKGROUND: Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. OBJECTIVE: The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. METHODS: DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. RESULTS: DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supported care vs usual care=.04, technology-facilitated care vs usual care=.03). Technology-facilitated care was significantly associated with depression remission (technology-facilitated care vs usual care: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: usual care=3.20, technology-facilitated care=3.70; P=.05); reduced total cholesterol level (LSE: usual care=176.40, technology-facilitated care=160.46; P=.01); improved satisfaction with diabetes care (LSE: usual care=4.01, technology-facilitated care=4.20; P=.05); and increased odds of taking an glycated hemoglobin test (technology-facilitated care vs usual care: OR=3.40, P<.001). CONCLUSIONS: Both the technology-facilitated care and supported care delivery models showed potential to improve 6-month depression and functional disability outcomes. The technology-facilitated care model has a greater likelihood to improve depression remission, patient satisfaction, and diabetes care quality.

How Resiliency Affects Quality of Life Twenty-two Years Post-cardiac Transplant: a Case Report.

Heart transplantation has been shown to prolong survival significantly for people who have advanced heart disease. Even with improved prognosis, heart transplant recipients experience a lower overall quality of life compared to their healthy counterparts, which is correlated with high rates of depression and other psychiatric disorders. Our case report examines factors affecting the quality of life over a long period of time in a patient who received a heart transplant 22 years ago. This case is unusual because the patient overcame depression with just a minimal dosage of antidepressants due to her unwavering hope, resilience, and strong social support. This case serves as a reminder to always consider every aspect of a patient's life, instead of just relying on high dose of medications, in order to improve their emotional and physical states and overall quality of life.